Provider Demographics
NPI:1912072000
Name:STANLEY, BRIAN DOUGLAS (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DOUGLAS
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 1:546 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7019
Mailing Address - Country:US
Mailing Address - Phone:907-376-2600
Mailing Address - Fax:907-376-2605
Practice Address - Street 1:546 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7019
Practice Address - Country:US
Practice Address - Phone:907-376-2600
Practice Address - Fax:907-376-2605
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHIC297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH02971Medicaid
586550001Medicare UPIN
AKCH02971Medicaid