Provider Demographics
NPI:1467576744
Name:CRAIG A STUTZMAN CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:CRAIG A STUTZMAN CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:STUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-495-8200
Mailing Address - Street 1:19 SEGOVIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28940 GOLDEN LANTERN
Practice Address - Street 2:SUITE I
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1500
Practice Address - Country:US
Practice Address - Phone:949-495-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty