Provider Demographics
NPI:1740358720
Name:PACIOREK, STACI MARAZONI (DC)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:MARAZONI
Last Name:PACIOREK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:MARAZONI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:12840 RIVERSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3327
Mailing Address - Country:US
Mailing Address - Phone:818-905-3313
Mailing Address - Fax:
Practice Address - Street 1:12840 RIVERSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3327
Practice Address - Country:US
Practice Address - Phone:818-905-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19528111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC019528OtherBLUE SHIELD
CADC019528OtherBLUE SHIELD