Provider Demographics
NPI:1164506747
Name:STONE, DOUGLAS CORNELIUS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CORNELIUS
Last Name:STONE
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 1:9001 MILLER RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1115
Mailing Address - Country:US
Mailing Address - Phone:810-635-8428
Mailing Address - Fax:810-635-4626
Practice Address - Street 1:9001 MILLER RD STE 4
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1115
Practice Address - Country:US
Practice Address - Phone:810-635-8428
Practice Address - Fax:810-635-4626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT322766Medicare UPIN
MI0B55066Medicare ID - Type Unspecified