Provider Demographics
NPI:1154546505
Name:STANDARD, PAULA (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:STANDARD
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 1:6855 SHORE TER
Mailing Address - Street 2:100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4662
Mailing Address - Country:US
Mailing Address - Phone:317-628-6480
Mailing Address - Fax:
Practice Address - Street 1:6855 SHORE TER
Practice Address - Street 2:100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4662
Practice Address - Country:US
Practice Address - Phone:317-628-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000713A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040510Medicaid
IN200040510Medicaid