Provider Demographics
NPI:1659760007
Name:STANFORD, ADDIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADDIE
Middle Name:
Last Name:STANFORD
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 1:575 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2593
Mailing Address - Country:US
Mailing Address - Phone:601-856-2383
Mailing Address - Fax:601-856-3955
Practice Address - Street 1:575 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2593
Practice Address - Country:US
Practice Address - Phone:601-856-2383
Practice Address - Fax:601-856-3955
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor