Provider Demographics
NPI:1154492395
Name:STANLEY, DON R JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:R
Last Name:STANLEY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:530 NEW LOS ANGELES AVE
Mailing Address - Street 2:SUITE #204
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2081
Mailing Address - Country:US
Mailing Address - Phone:805-523-7146
Mailing Address - Fax:805-523-7882
Practice Address - Street 1:530 NEW LOS ANGELES AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2081
Practice Address - Country:US
Practice Address - Phone:805-523-7146
Practice Address - Fax:805-523-7882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CADC23378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC23378AMedicare ID - Type Unspecified
CAU51019Medicare UPIN