Provider Demographics
NPI:1477512374
Name:TOLLEN, STUART B (DC)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:B
Last Name:TOLLEN
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 1:435 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2705
Mailing Address - Country:US
Mailing Address - Phone:215-885-8730
Mailing Address - Fax:215-885-7665
Practice Address - Street 1:435 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2705
Practice Address - Country:US
Practice Address - Phone:215-885-8730
Practice Address - Fax:215-885-7665
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004405L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA613831OtherPA BLUE SHIELD
PA613831XS3Medicare PIN