Provider Demographics
NPI:1619088820
Name:STOTLER, MICHAEL VERNON (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VERNON
Last Name:STOTLER
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:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-0260
Mailing Address - Country:US
Mailing Address - Phone:410-879-9013
Mailing Address - Fax:410-879-9015
Practice Address - Street 1:413 PULASKI HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3610
Practice Address - Country:US
Practice Address - Phone:410-679-8258
Practice Address - Fax:410-679-2681
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD339SMedicare PIN
MDV02374Medicare UPIN