Provider Demographics
NPI:1508086281
Name:STANDIFER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:STANDIFER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:STANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-623-0505
Mailing Address - Street 1:PO BOX 211251
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-4304
Mailing Address - Country:US
Mailing Address - Phone:214-623-0505
Mailing Address - Fax:214-623-0520
Practice Address - Street 1:3314 W KIEST BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-2102
Practice Address - Country:US
Practice Address - Phone:214-623-0505
Practice Address - Fax:214-623-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8482111N00000X, 111NN1001X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141697602Medicaid
TX7691324OtherAETNA
TXP00319103OtherMEDICARE RAILROAD
TX10862OtherPARKLAND
TX0021GWOtherBCBS GROUP
TX1003821778OtherPERSONAL NPI
TX1463325-01Medicaid
TX0073260OtherBCBS BLUE LINK
TX106750OtherAMERIGROUP
TX8B8920OtherBCBS PERSONAL
TX8B8920OtherBCBS PERSONAL
TXP00319103OtherMEDICARE RAILROAD
TX10862OtherPARKLAND