Provider Demographics
NPI:1831293877
Name:STANLEY, JAMES A (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:STANLEY
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 1:75-240 NANI KAILUA DR
Mailing Address - Street 2:6A
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2074
Mailing Address - Country:US
Mailing Address - Phone:808-326-9229
Mailing Address - Fax:808-326-1955
Practice Address - Street 1:75-240 NANI KAILUA DR
Practice Address - Street 2:6A
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2074
Practice Address - Country:US
Practice Address - Phone:808-326-9229
Practice Address - Fax:808-326-1955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI850OtherHI LICENSE
WACH00002374OtherWA LICENSE
HIA22832-8OtherHMSA PROVIDER #
HIH53493Medicare ID - Type UnspecifiedMEDICARE PARTICIPATING