Healthcare Provider Details

I. General information

NPI: 1477592020
Provider Name (Legal Business Name): MITCHELL SCOTT STANLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: SCOTT STANLEY

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E MAIN ST
RIVERTON WY
82501-4423
US

IV. Provider business mailing address

611 E MAIN ST
RIVERTON WY
82501-4423
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-4400
  • Fax: 307-856-9723
Mailing address:
  • Phone: 307-856-4400
  • Fax: 307-856-9723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number403
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5710
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: