Provider Demographics
NPI:1871553396
Name:FORD, STACIE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LEE
Last Name:FORD
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 1:41740 6 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3463
Mailing Address - Country:US
Mailing Address - Phone:248-465-0000
Mailing Address - Fax:248-465-0099
Practice Address - Street 1:41740 6 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3463
Practice Address - Country:US
Practice Address - Phone:248-465-0000
Practice Address - Fax:248-465-0099
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN50820003Medicare ID - Type Unspecified
MIMI5666002Medicare PIN
MIU98494Medicare UPIN