Provider Demographics
NPI:1386692234
Name:STUCKEY, MARK E (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:STUCKEY
Suffix:
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 1:109 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2894
Mailing Address - Country:US
Mailing Address - Phone:636-240-2225
Mailing Address - Fax:636-281-5377
Practice Address - Street 1:109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2894
Practice Address - Country:US
Practice Address - Phone:636-240-2225
Practice Address - Fax:636-281-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO005338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43539Medicare UPIN
MO31139Medicare ID - Type Unspecified