Provider Demographics
NPI:1164580155
Name:STANLEY, LANNY LAMON (DC)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:LAMON
Last Name:STANLEY
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 915
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-0915
Mailing Address - Country:US
Mailing Address - Phone:405-238-3709
Mailing Address - Fax:405-238-1877
Practice Address - Street 1:1555 W GRANT AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-1701
Practice Address - Country:US
Practice Address - Phone:405-238-3709
Practice Address - Fax:405-238-1877
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor