Provider Demographics
NPI:1962450403
Name:LACEY, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:LACEY
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:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2009
Mailing Address - Country:US
Mailing Address - Phone:843-237-1919
Mailing Address - Fax:843-237-7694
Practice Address - Street 1:9428 OCEAN HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8259
Practice Address - Country:US
Practice Address - Phone:843-237-1919
Practice Address - Fax:843-237-7694
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0982Medicaid
SCCH0982Medicaid