Individual
DR. STACEY SCOT CONRAD
Active
Individual
DR. STACEY SCOT CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
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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