Provider Demographics
NPI:1639113236
Name:STALEY, WILLIAM KURT (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KURT
Last Name:STALEY
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 1:810 TRAVELERS BLVD
Mailing Address - Street 2:SUITE H-1
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8260
Mailing Address - Country:US
Mailing Address - Phone:843-821-9929
Mailing Address - Fax:843-821-9270
Practice Address - Street 1:810 TRAVELERS BLVD
Practice Address - Street 2:SUITE H-1
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8258
Practice Address - Country:US
Practice Address - Phone:843-821-9929
Practice Address - Fax:843-821-9270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor