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General NPI Number Information
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NPI Number | 1124583885
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Entity Type | Individual
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Provider Name | SAMANTHA JO LYNETTE STATON DC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 17429 BRIDGE HILL CT
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City | TAMPA
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State | FL
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Zip | 33647-3467
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Country | US
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Telephone | 813-983-7921
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Fax |
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Provider Business Mailing Address
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Address Line | 28360 CR 280
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City | CARROLLTON
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State | MO
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Zip | 64633-8560
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Country | US
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Telephone | 660-322-1712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH14555
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License Number State | FL
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