Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8482 | TX |
N | 111NN1001X | Nutrition | 8482 | TX |
N | 111NP0017X | Pediatric Chiropractor | 8482 | TX |
N | 111NR0200X | Radiology | 8482 | TX |
N | 213ER0200X | Radiology | 8482 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 8482 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 8482 | TX |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 8482 | TX |
NPI | 1003821778 |
---|---|
Provider Name | Dr. Jeffrey Shawn Standifer |
First Address | Dallas, TX 75211-4304 |
Second Address | Dallas, TX 75233-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 12/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106750 | AMERIGROUP (01) | TX |
10862 | PARKLAND (01) | TX |
146332501 | (05) | TX |
7691324 | AETNA (01) | TX |
8B8920 | BLUE CROSS BLUE SHIELD (01) | TX |
U82778 | (02) | TX |