Provider Demographics
NPI:1811909120
Name:GRAY, STACY CHAPMAN (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:CHAPMAN
Last Name:GRAY
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 1:4908 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4914
Mailing Address - Country:US
Mailing Address - Phone:919-850-2440
Mailing Address - Fax:919-850-2441
Practice Address - Street 1:4908 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4914
Practice Address - Country:US
Practice Address - Phone:919-850-2440
Practice Address - Fax:919-850-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890859FMedicaid
NC2450287AMedicare ID - Type Unspecified