Provider Demographics
NPI:1356944847
Name:VENANZI, LACEY N (DC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:N
Last Name:VENANZI
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 1:765 SIENNA STATION WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1364
Mailing Address - Country:US
Mailing Address - Phone:949-383-7836
Mailing Address - Fax:
Practice Address - Street 1:475 E GREG ST STE 107
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8517
Practice Address - Country:US
Practice Address - Phone:949-383-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty