Provider Demographics
NPI:1437604303
Name:STOTZ, BRYAN (DC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:STOTZ
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 1:1625 ROSWELL RD
Mailing Address - Street 2:1023
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3682
Mailing Address - Country:US
Mailing Address - Phone:734-320-0183
Mailing Address - Fax:
Practice Address - Street 1:325 S ATLANTA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4934
Practice Address - Country:US
Practice Address - Phone:404-474-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor