Provider Demographics
NPI:1376577650
Name:CUSAK, STANLEY M (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:CUSAK
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 N 1ST ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2954
Mailing Address - Country:US
Mailing Address - Phone:559-435-5500
Mailing Address - Fax:559-435-5565
Practice Address - Street 1:7339 N 1ST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2954
Practice Address - Country:US
Practice Address - Phone:559-435-5500
Practice Address - Fax:559-435-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11292111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic