Provider Demographics
NPI:1477011245
Name:STAYTON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:STAYTON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-767-3410
Mailing Address - Street 1:561 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1703
Mailing Address - Country:US
Mailing Address - Phone:503-767-3410
Mailing Address - Fax:503-767-3411
Practice Address - Street 1:561 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1703
Practice Address - Country:US
Practice Address - Phone:503-767-3410
Practice Address - Fax:503-767-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty