Provider Demographics
NPI:1003821778
Name:STANDIFER, JEFFREY SHAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SHAWN
Last Name:STANDIFER
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:PO BOX 211251
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-4304
Mailing Address - Country:US
Mailing Address - Phone:214-623-0505
Mailing Address - Fax:214-623-0520
Practice Address - Street 1:3314 W KIEST BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-2102
Practice Address - Country:US
Practice Address - Phone:214-623-0505
Practice Address - Fax:214-623-0520
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8482111N00000X, 111NN1001X, 111NX0800X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106750OtherAMERIGROUP
TX146332501Medicaid
TX10862OtherPARKLAND
TX7691324OtherAETNA
TX8B8920OtherBLUE CROSS BLUE SHIELD
TXU82778Medicare UPIN
TX146332501Medicaid