Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4880 | NC |
NPI | 1003315805 |
---|---|
Provider Name | Dr. Stacey Rodsater |
First Address | Huntersville, NC 28078-5008 |
Second Address | Huntersville, NC 28078-5008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 07/02/2018 |