MEDICARE: DR. STACEY LYN WIRTANEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6607	TX

General Provider Information

NPI Number	:	1326172289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY LYN WIRTANEN D.C.

Provider Business Mailing Address
First Line	:	1606 BAYRAM DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3216
Country	:	US
Telephone Number	:	713-468-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 W T C JESTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1256
Country	:	US
Telephone Number	:	713-868-3223
Fax Number	:	713-868-1413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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