Individual
DR. STACEY SCOT CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
8924 E 96TH ST, FISHERS, IN 46037-9648
(317) 841-2700
(317) 841-2733
Mailing address
4949 JENNINGS DR, CARMEL, IN 46033-9786
(317) 575-8118
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
08001084A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092856
ANTHEM PIN NUMBER
IN
05
—
100126630A
—
IN
Enumeration date
05/16/2006
Last updated
03/25/2011
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