Provider Demographics
NPI:1811902125
Name:HARRIS, STACY PETERS (DC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:PETERS
Last Name:HARRIS
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 1:709 EAST LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120
Mailing Address - Country:US
Mailing Address - Phone:817-451-7979
Mailing Address - Fax:817-451-7545
Practice Address - Street 1:709 EAST LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120
Practice Address - Country:US
Practice Address - Phone:817-451-7979
Practice Address - Fax:817-451-7545
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX5222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90179Medicare UPIN
8F1854Medicare ID - Type Unspecified