Provider Demographics
NPI:1114134483
Name:STILES, PAUL ROBERT (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:STILES
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43269 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1737
Mailing Address - Country:US
Mailing Address - Phone:248-349-5170
Mailing Address - Fax:248-349-1997
Practice Address - Street 1:43269 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1737
Practice Address - Country:US
Practice Address - Phone:248-349-5170
Practice Address - Fax:248-349-1997
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPS007285111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35409OtherBLUE CROSS BLUE SHIELD
MI0F35409Medicare ID - Type Unspecified