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General NPI Number Information
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NPI Number | 1902496078
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Entity Type | Individual
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Provider Name | HOLDEN J. STANFILL DC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 16111 MANCHESTER RD STE 202
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City | ELLISVILLE
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State | MO
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Zip | 63011-2489
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Country | US
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Telephone | 636-735-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 461 ELM CROSSING CT
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City | BALLWIN
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State | MO
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Zip | 63021-7477
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Country | US
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Telephone | 731-358-8105
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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 | 2021002719
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License Number State | MO
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