Provider Demographics
NPI:1972671741
Name:STACEY MARSHALL D.C., P.C.
Entity Type:Organization
Organization Name:STACEY MARSHALL D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-922-4606
Mailing Address - Street 1:72 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2211
Mailing Address - Country:US
Mailing Address - Phone:516-922-4606
Mailing Address - Fax:516-922-4399
Practice Address - Street 1:72 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2211
Practice Address - Country:US
Practice Address - Phone:516-922-4606
Practice Address - Fax:516-922-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6296440001Medicare PIN
NYXFW311Medicare ID - Type UnspecifiedCHIROPRACTOR
6296440001Medicare NSC