1508086281 NPI number — STANDIFER CHIROPRACTIC CLINIC, P.C.

Table of content: (NPI 1508086281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508086281 NPI number — STANDIFER CHIROPRACTIC CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANDIFER CHIROPRACTIC CLINIC, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508086281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 211251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75211-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-623-0505
Provider Business Mailing Address Fax Number:
214-623-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3314 W KIEST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75233-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-623-0505
Provider Business Practice Location Address Fax Number:
214-623-0520
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STANDIFER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
SHAWN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-623-0505

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NN1001X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NP0017X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0200X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 8482 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141697602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7691324 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00319103 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10862 . This is a "PARKLAND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0021GW . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1003821778 . This is a "PERSONAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1463325-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0073260 . This is a "BCBS BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 106750 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8B8920 . This is a "BCBS PERSONAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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