=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770736167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPSTONE HEALTHCARE. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 W JASPER DR STE 1
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-200-0401
-----------------------------------------------------
Fax | 254-200-0405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 W JASPER DR STE 1
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76542-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-200-0401
-----------------------------------------------------
Fax | 254-200-0405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | DR. CURTIS STACY III
-----------------------------------------------------
Credential | D.C., F.I.A.M.A.
-----------------------------------------------------
Telephone | 254-200-0041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 8758
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------