Provider Demographics
NPI:1538473319
Name:STULL, PATRICK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:STULL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 INTERSTATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6187
Mailing Address - Country:US
Mailing Address - Phone:931-456-8880
Mailing Address - Fax:931-456-8883
Practice Address - Street 1:1364 INTERSTATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6187
Practice Address - Country:US
Practice Address - Phone:931-456-8880
Practice Address - Fax:931-456-8883
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556832111N00000X
TN2895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q359859763Medicare PIN