MEDICARE: DR. STACEY LEIGH BLAIR DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.010887	IL
2	111N00000X	Chiropractor	2006028734	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212982	OTHER	MO	ANTHEM BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548344070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY LEIGH BLAIR DC

Provider Business Mailing Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 107
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-961-7181
Fax Number	:	314-961-6323

Provider Business Practice Location Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 107
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-961-7181
Fax Number	:	314-961-6323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/29/2008

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