Provider Demographics
NPI:1487646766
Name:STANLEY, BRENT RAY (DC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:RAY
Last Name:STANLEY
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 1:1723 HIGHWAY BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2200
Mailing Address - Country:US
Mailing Address - Phone:712-262-5510
Mailing Address - Fax:712-262-5511
Practice Address - Street 1:1723 HIGHWAY BLVD
Practice Address - Street 2:STE 2
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2200
Practice Address - Country:US
Practice Address - Phone:712-262-5510
Practice Address - Fax:712-262-5511
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1189050Medicaid
IAI5017Medicare ID - Type Unspecified
IA1189050Medicaid