Provider Demographics
NPI:1700160116
Name:GARNER, STACEY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEE
Last Name:GARNER
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 1:2555 GANESHA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2505
Mailing Address - Country:US
Mailing Address - Phone:626-660-6253
Mailing Address - Fax:626-798-0949
Practice Address - Street 1:2555 GANESHA AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2505
Practice Address - Country:US
Practice Address - Phone:626-660-6253
Practice Address - Fax:626-798-0949
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26720111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation