Provider Demographics
NPI:1043324494
Name:SEWELL, STANLEY D (DC)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:SEWELL
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 1:722 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-2957
Mailing Address - Country:US
Mailing Address - Phone:254-562-2112
Mailing Address - Fax:254-562-5266
Practice Address - Street 1:722 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2957
Practice Address - Country:US
Practice Address - Phone:254-562-2112
Practice Address - Fax:254-562-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0444630 01Medicaid
TX85W552OtherBLUE CROSS BLUE SHIELD
TX85W552OtherBLUE CROSS BLUE SHIELD
TX0444630 01Medicaid