Provider Demographics
NPI:1831805175
Name:STACEY, MICHAEL WELDON (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WELDON
Last Name:STACEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 BOSQUE BLVD STE 131
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4020
Mailing Address - Country:US
Mailing Address - Phone:254-218-3161
Mailing Address - Fax:
Practice Address - Street 1:5201 BOSQUE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4676
Practice Address - Country:US
Practice Address - Phone:254-265-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor