Provider Demographics
NPI:1639110984
Name:STAFFORD, SHARON DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:DENISE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 OXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3747
Mailing Address - Country:US
Mailing Address - Phone:972-352-5315
Mailing Address - Fax:
Practice Address - Street 1:2840 KELLER SPRINGS RD STE 301
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4849
Practice Address - Country:US
Practice Address - Phone:972-418-5150
Practice Address - Fax:972-416-6827
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3809OtherBLUE CROSS BLUE SHIELD
TX2161135OtherFIRST SPECIALTY HEALTH
TXV03783Medicare UPIN
TX2161135OtherFIRST SPECIALTY HEALTH