Provider Demographics
NPI:1346387958
Name:STOTTER, ALIYAH T (DC)
Entity Type:Individual
Prefix:
First Name:ALIYAH
Middle Name:T
Last Name:STOTTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4004
Mailing Address - Country:US
Mailing Address - Phone:770-713-1796
Mailing Address - Fax:
Practice Address - Street 1:9720 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4004
Practice Address - Country:US
Practice Address - Phone:954-752-7373
Practice Address - Fax:954-752-7364
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor