Provider Demographics
NPI:1700953247
Name:STANLEY FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:STANLEY FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:LAMON
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-238-3709
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075
Mailing Address - Country:US
Mailing Address - Phone:405-238-3709
Mailing Address - Fax:405-238-1877
Practice Address - Street 1:1555 W GRANT
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-238-3709
Practice Address - Fax:405-238-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK441907238002OtherBLUE CROSS BLUE SHIELD
OK446720429002OtherBLUE CROSS BLUE SHIELD
OK300522045Medicare PIN