Provider Demographics
NPI:1356342711
Name:LANG, STACEY WEICHERS (DC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:WEICHERS
Last Name:LANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:STACEYK
Other - Middle Name:WICHERS
Other - Last Name:DANGREMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8459 US HIGHWAY 42
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8350
Mailing Address - Country:US
Mailing Address - Phone:859-283-5070
Mailing Address - Fax:859-283-5071
Practice Address - Street 1:8459 US HIGHWAY 42
Practice Address - Street 2:SUITE E
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8350
Practice Address - Country:US
Practice Address - Phone:859-283-5070
Practice Address - Fax:859-283-5071
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000214501OtherANTHEM
KY7795285OtherAETNA
KY85002145Medicaid
KY1193041OtherCHA
KYKY669COtherHUMANA
KY000000214501OtherANTHEM
KY1193041OtherCHA