Provider Demographics
NPI:1548330806
Name:CORRADO, STACY L (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:CORRADO
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 1:198 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-7917
Mailing Address - Country:US
Mailing Address - Phone:586-465-6111
Mailing Address - Fax:586-465-6100
Practice Address - Street 1:35737 HARPER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3210
Practice Address - Country:US
Practice Address - Phone:586-465-6111
Practice Address - Fax:586-465-6100
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW007428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301007428OtherMICHIGAN LICENSE