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General NPI Number Information
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NPI Number | 1972671741
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Entity Type | Organization
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Legal Business Name | STACEY MARSHALL D.C., P.C.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 72 W MAIN ST
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City | OYSTER BAY
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State | NY
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Zip | 11771-2211
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Country | US
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Telephone | 516-922-4606
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Fax | 516-922-4399
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Provider Business Mailing Address
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Address Line | 72 W MAIN ST
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City | OYSTER BAY
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State | NY
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Zip | 11771-2211
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Country | US
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Telephone | 516-922-4606
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Fax | 516-922-4399
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACEY LYNN MARSHALL
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Credential | D.C.
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Telephone | 516-922-4606
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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 | X008337
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License Number State | NY
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