Provider Demographics
NPI:1902902588
Name:STANLEY, LAURI MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURI
Middle Name:MICHELLE
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 1:20079 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-6037
Mailing Address - Country:US
Mailing Address - Phone:352-489-2995
Mailing Address - Fax:352-465-4809
Practice Address - Street 1:20079 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6037
Practice Address - Country:US
Practice Address - Phone:352-489-2995
Practice Address - Fax:352-465-4809
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL629060OtherUNITED HEALTHCARE
FL5802696OtherGHI
FL283903OtherAVMED
FL5802696OtherGHI
FL283903OtherAVMED