Provider Demographics
NPI:1528490745
Name:KAVNAUGH, STACEY COE (DC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:COE
Last Name:KAVNAUGH
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 1:3034 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1289
Mailing Address - Country:US
Mailing Address - Phone:805-423-3379
Mailing Address - Fax:
Practice Address - Street 1:1051 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5603
Practice Address - Country:US
Practice Address - Phone:805-423-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 32434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor