Provider Demographics
NPI:1871623959
Name:LOWE, STACEY RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:RENEE
Last Name:LOWE
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 1:501 N KNIK STREET
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8302
Mailing Address - Country:US
Mailing Address - Phone:907-373-4325
Mailing Address - Fax:907-376-7440
Practice Address - Street 1:501 N KNIK ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7050
Practice Address - Country:US
Practice Address - Phone:907-373-4325
Practice Address - Fax:907-376-7440
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0404Medicaid
AKCH0404Medicaid