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General NPI Number Information
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NPI Number | 1699887745
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Entity Type | Individual
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Provider Name | STACEY LYNN DEWOLF DC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 7328 E DEER VALLEY RD SUITE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7454
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Country | US
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Telephone | 480-282-8485
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Fax | 480-323-2777
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Provider Business Mailing Address
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Address Line | PO BOX 4457
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City | CAVE CREEK
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State | AZ
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Zip | 85327-4457
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Country | US
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Telephone | 480-282-8485
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Fax | 480-323-2777
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7685
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4369
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License Number State | AZ
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