Provider Demographics
NPI:1124049952
Name:STACKS, JOHN P JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:STACKS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 STAGE VILLAGE CV STE 1
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4682
Mailing Address - Country:US
Mailing Address - Phone:901-377-8600
Mailing Address - Fax:901-377-5426
Practice Address - Street 1:2850 STAGE VILLAGE CV
Practice Address - Street 2:STE 1
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4682
Practice Address - Country:US
Practice Address - Phone:901-377-8600
Practice Address - Fax:901-377-5426
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND.C.00378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673065Medicare ID - Type Unspecified
TNT74566Medicare UPIN