MEDICARE: DR. STACY BURLIN WARNER 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	6942	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	98122	OTHER	AR	AR BLUE CROSS/BLUE SHIELD
2	00000005HJ	OTHER	TX	TX BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1760474795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY BURLIN WARNER D.C.

Provider Business Mailing Address
First Line	:	4412 W 7TH ST
Second Line	:
City	:	WAKE VILLAGE
State	:	TX
Zip	:	75501-6352
Country	:	US
Telephone Number	:	903-334-9110
Fax Number	:	903-223-3753

Provider Business Practice Location Address
First Line	:	4412 W 7TH ST
Second Line	:
City	:	WAKE VILLAGE
State	:	TX
Zip	:	75501-6352
Country	:	US
Telephone Number	:	903-334-9110
Fax Number	:	903-223-3753

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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