Provider Demographics
NPI:1295123024
Name:STANFORD, NATHAN ELDON (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ELDON
Last Name:STANFORD
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 1:2816 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4782
Mailing Address - Country:US
Mailing Address - Phone:509-535-5771
Mailing Address - Fax:509-535-5782
Practice Address - Street 1:2816 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4782
Practice Address - Country:US
Practice Address - Phone:509-535-5771
Practice Address - Fax:509-535-5782
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-01
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60453660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8937228OtherMEDICARE PTAN (GROUP)
WAG8937229OtherMEDICARE PTAN (INDIVIDUAL)