Provider Demographics
NPI:1477595692
Name:STANFIELD, CHARLES R (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:STANFIELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6429
Mailing Address - Country:US
Mailing Address - Phone:732-341-0070
Mailing Address - Fax:732-341-0270
Practice Address - Street 1:1000 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6429
Practice Address - Country:US
Practice Address - Phone:732-341-0070
Practice Address - Fax:732-341-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ181011Medicare PIN