Provider Demographics
NPI:1497033666
Name:SEARS, STANLEY N (DC)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:N
Last Name:SEARS
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 1:2309 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-2256
Mailing Address - Country:US
Mailing Address - Phone:208-454-0787
Mailing Address - Fax:208-459-3137
Practice Address - Street 1:2309 TERRACE DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-2256
Practice Address - Country:US
Practice Address - Phone:208-454-0787
Practice Address - Fax:208-459-3137
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-678111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor