Provider Demographics
NPI:1174903777
Name:STICE, LACY LE ANN (DC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:LE ANN
Last Name:STICE
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 1:4623 S COOPER ST STE 135
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5831
Mailing Address - Country:US
Mailing Address - Phone:817-701-4345
Mailing Address - Fax:817-701-4349
Practice Address - Street 1:4623 S COOPER ST STE 135
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5831
Practice Address - Country:US
Practice Address - Phone:817-701-4345
Practice Address - Fax:817-701-4349
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor