Provider Demographics
NPI:1366765950
Name:STANLEY, KRISTINA LISA (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LISA
Last Name:STANLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 N WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4764
Mailing Address - Country:US
Mailing Address - Phone:972-849-0578
Mailing Address - Fax:
Practice Address - Street 1:1721 N WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4764
Practice Address - Country:US
Practice Address - Phone:972-849-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor