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General NPI Number Information
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NPI Number | 1164925988
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Entity Type | Individual
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Provider Name | STACEY WHITCOMB LAC.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 750 E WARM SPRINGS AVE STE G
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City | BOISE
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State | ID
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Zip | 83712-6457
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Country | US
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Telephone | 208-336-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 3735 E HAYSTACK ST APT 203
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City | BOISE
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State | ID
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Zip | 83716-6008
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Country | US
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Telephone | 208-336-1133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 9271247
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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