Provider Demographics
NPI:1780744169
Name:SHARLET, STACY (DC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SHARLET
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 1:1569 SW NANCY WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3234
Mailing Address - Country:US
Mailing Address - Phone:541-389-3406
Mailing Address - Fax:541-303-1449
Practice Address - Street 1:1569 SW NANCY WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3234
Practice Address - Country:US
Practice Address - Phone:541-389-3406
Practice Address - Fax:541-389-3492
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR27-3104111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health