MEDICARE: STANDIFER CHIROPRACTIC CLINIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NP0017X	Pediatric Chiropractor	8482	TX
2	111NR0200X	Radiology Chiropractor	8482	TX
3	111NR0400X	Rehabilitation Chiropractor	8482	TX
4	111NS0005X	Sports Physician Chiropractor	8482	TX
5	111NN1001X	Nutrition Chiropractor	8482	TX
6	111NX0800X	Orthopedic Chiropractor	8482	TX
7	111N00000X	Chiropractor	8482	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00319103	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7691324	OTHER	TX	AETNA
4	10862	OTHER	TX	PARKLAND
5	0021GW	OTHER	TX	BCBS GROUP
6	1003821778	OTHER	TX	PERSONAL NPI
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0073260	OTHER	TX	BCBS BLUE LINK
9	106750	OTHER	TX	AMERIGROUP
10	8B8920	OTHER	TX	BCBS PERSONAL

General Provider Information

NPI Number	:	1508086281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANDIFER CHIROPRACTIC CLINIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 211251
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-4304
Country	:	US
Telephone Number	:	214-623-0505
Fax Number	:	214-623-0520

Provider Business Practice Location Address
First Line	:	3314 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-2102
Country	:	US
Telephone Number	:	214-623-0505
Fax Number	:	214-623-0520

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY SHAWN STANDIFER
Credential	:	D.C.
Telephone Number	:	214-623-0505

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	12/14/2008

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Directions to “STANDIFER CHIROPRACTIC CLINIC, P.C. ” Practice Location

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