Provider Demographics
NPI:1609026566
Name:STIMSON, CARL A (LIC AC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:STIMSON
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CHESTNUT HILL AVE
Mailing Address - Street 2:APT.# 7
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4649
Mailing Address - Country:US
Mailing Address - Phone:406-449-2689
Mailing Address - Fax:
Practice Address - Street 1:6123 MOODANCE ROAD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-449-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist