Provider Demographics
NPI:1447811500
Name:STALEY, LANDON JAY (DC)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:JAY
Last Name:STALEY
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 1:1091 N BLUFF ST STE 1505
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7053
Mailing Address - Country:US
Mailing Address - Phone:435-233-6075
Mailing Address - Fax:
Practice Address - Street 1:1091 N BLUFF ST STE 1505
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7053
Practice Address - Country:US
Practice Address - Phone:435-233-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11351653-1202111N00000X, 111NP0017X, 111NT0100X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NT0100XChiropractic ProvidersChiropractorThermography