Provider Demographics
NPI:1760474795
Name:WARNER, STACY BURLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:BURLIN
Last Name:WARNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-6352
Mailing Address - Country:US
Mailing Address - Phone:903-334-9110
Mailing Address - Fax:903-223-3753
Practice Address - Street 1:4412 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-6352
Practice Address - Country:US
Practice Address - Phone:903-334-9110
Practice Address - Fax:903-223-3753
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR98122OtherAR BLUE CROSS/BLUE SHIELD
TX00000005HJOtherTX BLUE CROSS/BLUE SHIELD
TX00000005HJOtherTX BLUE CROSS/BLUE SHIELD