Provider Demographics
NPI:1356482707
Name:STANTON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:STANTON CHIROPRACTIC, INC.
Other - Org Name:LIFELINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-662-2142
Mailing Address - Street 1:2975 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4117
Mailing Address - Country:US
Mailing Address - Phone:714-662-2142
Mailing Address - Fax:
Practice Address - Street 1:2975 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4117
Practice Address - Country:US
Practice Address - Phone:714-662-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID