Provider Demographics
NPI:1073646634
Name:STANTON, WILLIAM WEB (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WEB
Last Name:STANTON
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 804
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-0804
Mailing Address - Country:US
Mailing Address - Phone:970-532-4616
Mailing Address - Fax:970-532-4750
Practice Address - Street 1:120 BUNYAN AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-1188
Practice Address - Country:US
Practice Address - Phone:970-532-4616
Practice Address - Fax:970-532-4750
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU33373Medicare UPIN
CO27973Medicare ID - Type Unspecified