Provider Demographics
NPI:1891828786
Name:STANLEY HEALTH CLINICS PC
Entity Type:Organization
Organization Name:STANLEY HEALTH CLINICS PC
Other - Org Name:BACK AND NECK PAIN RELIEF CENTER OF WASILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-376-2600
Mailing Address - Street 1:300 W SWANSON AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6827
Mailing Address - Country:US
Mailing Address - Phone:907-376-2600
Mailing Address - Fax:907-376-2605
Practice Address - Street 1:300 W SWANSON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6827
Practice Address - Country:US
Practice Address - Phone:907-376-2600
Practice Address - Fax:907-376-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCH0295111N00000X
AKCH02971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1992875777OtherNPI
AK1912072000OtherNPI
AK1912072000OtherNPI
AK1912072000OtherNPI
AK1992875777OtherNPI
AKK00WFBYX-BMedicare ID - Type Unspecified