Provider Demographics
NPI:1669437422
Name:STANLEY FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:STANLEY FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-262-5510
Mailing Address - Street 1:1723 HIGHWAY BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2200
Mailing Address - Country:US
Mailing Address - Phone:712-262-5510
Mailing Address - Fax:712-262-5511
Practice Address - Street 1:1723 HIGHWAY BLVD
Practice Address - Street 2:STE 2
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2200
Practice Address - Country:US
Practice Address - Phone:712-262-5510
Practice Address - Fax:712-262-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1189050Medicaid
IA0285213Medicaid
IA1189050Medicaid
IA0285213Medicaid