Provider Demographics
NPI:1558581744
Name:STAHL, MICHAEL DAVID (D,C,)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:STAHL
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 N. MAIN ST.
Mailing Address - Street 2:P.O. BOX 25
Mailing Address - City:BRIDGEWATER
Mailing Address - State:SD
Mailing Address - Zip Code:57319
Mailing Address - Country:US
Mailing Address - Phone:605-729-2700
Mailing Address - Fax:605-729-2700
Practice Address - Street 1:232 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:SD
Practice Address - Zip Code:57319
Practice Address - Country:US
Practice Address - Phone:605-729-2700
Practice Address - Fax:605-729-2700
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS5311Medicare ID - Type UnspecifiedMEDICARE PART B