Provider Demographics
NPI:1154448371
Name:STILTNER, JOHN HARVARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARVARD
Last Name:STILTNER
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 1:1218 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-736-0145
Mailing Address - Fax:360-736-0146
Practice Address - Street 1:1218 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-736-0145
Practice Address - Fax:360-736-0146
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAST0456OtherREGENCE
WA14878OtherL AND I
WAST0456OtherREGENCE