Provider Demographics
NPI:1164555850
Name:STANKOVIC, SAMUELA C (DC)
Entity Type:Individual
Prefix:
First Name:SAMUELA
Middle Name:C
Last Name:STANKOVIC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 RIVER BRANCH TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3795
Mailing Address - Country:US
Mailing Address - Phone:972-772-4878
Mailing Address - Fax:
Practice Address - Street 1:2920 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5803
Practice Address - Country:US
Practice Address - Phone:972-772-4878
Practice Address - Fax:
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
TX8224111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation