Provider Demographics
NPI:1841608536
Name:GAMMAGE, STACIA (DC,AT)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:GAMMAGE
Suffix:
Gender:F
Credentials:DC,AT
Other - Prefix:
Other - First Name:STACIA
Other - Middle Name:
Other - Last Name:LAPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT
Mailing Address - Street 1:5521 BELLAIRE DR S STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5855
Mailing Address - Country:US
Mailing Address - Phone:817-926-9642
Mailing Address - Fax:817-926-1865
Practice Address - Street 1:5521 BELLAIRE DR S STE 110
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5855
Practice Address - Country:US
Practice Address - Phone:817-926-9642
Practice Address - Fax:817-926-1865
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT5862255A2300X
TX15708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer