Provider Demographics
NPI:1538487624
Name:STANFIELD, DAREK W (DC)
Entity type:Individual
Prefix:
First Name:DAREK
Middle Name:W
Last Name:STANFIELD
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 1:10379 GOLDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8648
Mailing Address - Country:US
Mailing Address - Phone:386-871-6925
Mailing Address - Fax:
Practice Address - Street 1:10379 GOLDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8648
Practice Address - Country:US
Practice Address - Phone:386-871-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
OH4632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538487624OtherANTHEM
VA3247728OtherMAMSI
VA1675-0006OtherCAREFIRST BLUE CROSS
VA751259OtherA CN