MEDICARE: DR. TROY DENNIS STUCKEY

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	3784	MN

General Provider Information

NPI Number	:	1639277841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY DENNIS STUCKEY

Provider Business Mailing Address
First Line	:	2574 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-3712
Country	:	US
Telephone Number	:	651-779-8883
Fax Number	:	651-779-8898

Provider Business Practice Location Address
First Line	:	2574 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55113-3712
Country	:	US
Telephone Number	:	651-779-8883
Fax Number	:	651-779-8898

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/26/2008

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