Provider Demographics
NPI:1023094018
Name:ADDESSI, STACI JOY (DC)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:JOY
Last Name:ADDESSI
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 1:401 BUCHANAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5319
Mailing Address - Country:US
Mailing Address - Phone:732-747-1464
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:SUITE 29 BUILDING 2
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-739-3345
Practice Address - Fax:732-739-3376
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00604200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3491525OtherOXFORD
NJ086805Medicare ID - Type Unspecified