Provider Demographics
NPI:1023087335
Name:STAPLEFORD, KEVIN J (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:STAPLEFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 S ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-3418
Mailing Address - Country:US
Mailing Address - Phone:515-964-8547
Mailing Address - Fax:515-964-8563
Practice Address - Street 1:629 S ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-3418
Practice Address - Country:US
Practice Address - Phone:515-964-8547
Practice Address - Fax:515-964-8563
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42963Medicare ID - Type Unspecified