Provider Demographics
NPI:1114465986
Name:CRAIG A STUTZMAN CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CRAIG A STUTZMAN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-412-9366
Mailing Address - Street 1:30 GEMA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9408
Mailing Address - Country:US
Mailing Address - Phone:949-412-9366
Mailing Address - Fax:
Practice Address - Street 1:23695 BIRTCHER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1782
Practice Address - Country:US
Practice Address - Phone:949-586-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty