Provider Demographics
NPI:1740248723
Name:DAVIS, STACEY M (DC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:8070 E MORGAN TRL
Mailing Address - Street 2:#125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1227
Mailing Address - Country:US
Mailing Address - Phone:480-998-7627
Mailing Address - Fax:480-998-2309
Practice Address - Street 1:8070 E MORGAN TRL
Practice Address - Street 2:#125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1227
Practice Address - Country:US
Practice Address - Phone:480-998-7627
Practice Address - Fax:480-998-2309
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2015-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ7336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128703OtherPTAN
AZZ104267Medicare PIN
AZU98659Medicare UPIN