Provider Demographics
NPI:1336317064
Name:STANISLAWSKI, EDWARD DONALD (DC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DONALD
Last Name:STANISLAWSKI
Suffix:
Gender:M
Credentials:DC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 VENTURA BLVD STE. LL07
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5134
Mailing Address - Country:US
Mailing Address - Phone:818-783-4085
Mailing Address - Fax:818-783-4065
Practice Address - Street 1:17609 VENTURA BLVD STE. LL07
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5134
Practice Address - Country:US
Practice Address - Phone:818-783-4085
Practice Address - Fax:818-783-4065
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor