Healthcare Provider Details

I. General information

NPI: 1881783082
Provider Name (Legal Business Name): STACY E WALKER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 58TH ST N STE 303
CLEARWATER FL
33760-3759
US

IV. Provider business mailing address

13770 58TH ST N STE 303
CLEARWATER FL
33760-3759
US

V. Phone/Fax

Practice location:
  • Phone: 727-532-9700
  • Fax: 727-532-9744
Mailing address:
  • Phone: 727-532-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH6703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: