| Doctor Name: | STACEY ANNE DERSHAM |
| NPI Number: | 1871753228 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.C. |
| License Number: | |
| Business Practice Address: | 657 Pleasant St Box #5 Fall River, MA - 027214323 |
| Business Phone Number: | 5086772554 |
| Business Fax Number: | 5086772553 |
| Mailing Address: | 113 Braley Hill Rd, ROCHESTER |
| State: | MA |
| Postal Code: | 027701917 |
| Phone Number: | 5087258307 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2008 |
| NPI Last Update Date: | 11/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |