Provider Demographics
NPI:1477852044
Name:STANFIELD, JACK DEAN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:DEAN
Last Name:STANFIELD
Suffix:JR
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 1:613 N MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-8613
Mailing Address - Country:US
Mailing Address - Phone:785-766-9335
Mailing Address - Fax:
Practice Address - Street 1:3007 GARDEN GROVE PKWY
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-3907
Practice Address - Country:US
Practice Address - Phone:620-662-6160
Practice Address - Fax:620-662-5223
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor