Provider Demographics
NPI:1538431705
Name:SMITH, STACY-ANN SIMONE (DC)
Entity type:Individual
Prefix:DR
First Name:STACY-ANN
Middle Name:SIMONE
Last Name:SMITH
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 1:705 PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2537
Mailing Address - Country:US
Mailing Address - Phone:561-223-3340
Mailing Address - Fax:561-223-3249
Practice Address - Street 1:705 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2537
Practice Address - Country:US
Practice Address - Phone:561-223-3340
Practice Address - Fax:561-223-3249
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008927111N00000X
FLCH10700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor