MEDICARE: JERRY LYNN STANLEY D.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	111N00000X	Chiropractor	389	MT

General Provider Information

NPI Number	:	1821145947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY LYNN STANLEY D.C.

Provider Business Mailing Address
First Line	:	103 N 8TH ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-3208
Country	:	US
Telephone Number	:	406-234-2634
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 N 8TH ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-3208
Country	:	US
Telephone Number	:	406-234-2634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	04/29/2019

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