Provider Demographics
NPI:1801078365
Name:STAFFORD, JOHN A
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3564
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522
Mailing Address - Country:US
Mailing Address - Phone:312-437-4444
Mailing Address - Fax:630-323-4848
Practice Address - Street 1:1750 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:312-437-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0383397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor