Provider Demographics
NPI:1730203522
Name:STANLEY, PATRICK K (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
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 1:5586 EUREKA DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4268
Mailing Address - Country:US
Mailing Address - Phone:513-405-1580
Mailing Address - Fax:
Practice Address - Street 1:5586 EUREKA DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4268
Practice Address - Country:US
Practice Address - Phone:513-405-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46605Medicare UPIN
OHST0394502Medicare ID - Type Unspecified