Provider Demographics
NPI:1649404815
Name:STOETZEL CHIROPRACTIC CLINIC,PLLC
Entity Type:Organization
Organization Name:STOETZEL CHIROPRACTIC CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:STOETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-773-1177
Mailing Address - Street 1:1427 PETERS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4636
Mailing Address - Country:US
Mailing Address - Phone:336-773-1177
Mailing Address - Fax:
Practice Address - Street 1:1427 PETERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4636
Practice Address - Country:US
Practice Address - Phone:336-773-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOETZEL CHIROPRACTIC CLINIC,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty