=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538349048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DON R STANLEY JR DC & WENDY WOMACK STANLEY DC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2007
-----------------------------------------------------
Last Update Date | 03/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 NEW LOS ANGELES AVE STE 204
-----------------------------------------------------
City | MOORPARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93021-2080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-523-7146
-----------------------------------------------------
Fax | 805-523-7882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 NEW LOS ANGELES AVE STE 204
-----------------------------------------------------
City | MOORPARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93021-2080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-523-7146
-----------------------------------------------------
Fax | 805-523-7882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JESSICA BENITEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-523-7146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC23378
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------