Provider Demographics
NPI:1245262021
Name:BULA, STACY M (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:M
Last Name:BULA
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 1:537 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2229
Mailing Address - Country:US
Mailing Address - Phone:715-623-1191
Mailing Address - Fax:715-623-1191
Practice Address - Street 1:537 FIELD ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2229
Practice Address - Country:US
Practice Address - Phone:715-623-1191
Practice Address - Fax:715-623-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3830012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38939200Medicaid
WI38939200Medicaid