Provider Demographics
NPI:1851519615
Name:SOLACK, STANLEY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOSEPH
Last Name:SOLACK
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 1:503 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1323
Mailing Address - Country:US
Mailing Address - Phone:570-489-2437
Mailing Address - Fax:570-489-5156
Practice Address - Street 1:503 SUNSET DR
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1323
Practice Address - Country:US
Practice Address - Phone:570-489-2437
Practice Address - Fax:570-489-5156
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-OO1450-L111NR0400X
PADC-001450-L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA205279KCBMedicaid
PA668324Medicare ID - Type Unspecified
PAT28686Medicare UPIN