Provider Demographics
NPI:1700447422
Name:DR. LACY STICE, LLC
Entity Type:Organization
Organization Name:DR. LACY STICE, LLC
Other - Org Name:HEALTHY BALANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-948-4372
Mailing Address - Street 1:4621 S COOPER ST
Mailing Address - Street 2:SUITE 135 PMB 493
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017
Mailing Address - Country:US
Mailing Address - Phone:817-701-4345
Mailing Address - Fax:817-701-4349
Practice Address - Street 1:4623 S COOPER ST STE 135
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5831
Practice Address - Country:US
Practice Address - Phone:817-701-4345
Practice Address - Fax:817-701-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty