Provider Demographics
NPI:1114359262
Name:STUTMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:STUTMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-522-7746
Mailing Address - Street 1:2833 SMITH AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1426
Mailing Address - Country:US
Mailing Address - Phone:410-382-9555
Mailing Address - Fax:240-510-2178
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE STE 209
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6973
Practice Address - Country:US
Practice Address - Phone:301-431-2225
Practice Address - Fax:240-510-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S01906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty