Provider Demographics
NPI:1891269684
Name:BREHM, STACEY (DC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 BRIMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2816
Mailing Address - Country:US
Mailing Address - Phone:330-635-7231
Mailing Address - Fax:
Practice Address - Street 1:155 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1534
Practice Address - Country:US
Practice Address - Phone:330-723-1441
Practice Address - Fax:330-723-1881
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor