Provider Demographics
NPI:1265506463
Name:TAM, STACY ROBIN (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:ROBIN
Last Name:TAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-0003
Mailing Address - Country:US
Mailing Address - Phone:508-748-6633
Mailing Address - Fax:508-748-6649
Practice Address - Street 1:238 WAREHAM RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1166
Practice Address - Country:US
Practice Address - Phone:508-748-6633
Practice Address - Fax:508-748-6649
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7198894OtherAETNA
MAY37172OtherBCBS
MA1265506463OtherBMC HEALTHNET
MA1614142Medicaid
MA711883OtherUNITED HEALTHCARE
MA711883OtherACN NETWORK
MAAA96361OtherHARVARD PILGRAM
MA1265506463OtherBMC HEALTHNET