Provider Demographics
NPI:1538349048
Name:DON R STANLEY JR DC & WENDY WOMACK STANLEY DC
Entity type:Organization
Organization Name:DON R STANLEY JR DC & WENDY WOMACK STANLEY DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-523-7146
Mailing Address - Street 1:530 NEW LOS ANGELES AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2080
Mailing Address - Country:US
Mailing Address - Phone:805-523-7146
Mailing Address - Fax:805-523-7882
Practice Address - Street 1:530 NEW LOS ANGELES AVE STE 204
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2080
Practice Address - Country:US
Practice Address - Phone:805-523-7146
Practice Address - Fax:805-523-7882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DON R STANLEY JR DC & WENDY WOMACK STANLEY DC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-13
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13270OtherMEDICARE PROVIDER #