Provider Demographics
NPI:1891720116
Name:TALAN, STACI J (DC)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:J
Last Name:TALAN
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 1:39809 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2974
Mailing Address - Country:US
Mailing Address - Phone:510-657-1234
Mailing Address - Fax:510-657-1233
Practice Address - Street 1:39809 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2974
Practice Address - Country:US
Practice Address - Phone:510-657-1234
Practice Address - Fax:510-657-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0286070Medicare ID - Type Unspecified
CAU97049Medicare UPIN