Provider Demographics
NPI:1235535907
Name:STANFORD CHIROPRACTIC
Entity Type:Organization
Organization Name:STANFORD CHIROPRACTIC
Other - Org Name:POSTLETHWAITE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-535-5771
Mailing Address - Street 1:2816 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4782
Mailing Address - Country:US
Mailing Address - Phone:509-535-5771
Mailing Address - Fax:509-535-5782
Practice Address - Street 1:2816 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4782
Practice Address - Country:US
Practice Address - Phone:509-535-5771
Practice Address - Fax:509-535-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60453660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8937228OtherPTAN
WAG8937229OtherPTAN