Provider Demographics
NPI:1659464436
Name:STELTER, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:STELTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 TWILIGHT ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1150
Mailing Address - Country:US
Mailing Address - Phone:321-956-6678
Mailing Address - Fax:321-952-1187
Practice Address - Street 1:1747 EVANS RD
Practice Address - Street 2:101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3869
Practice Address - Country:US
Practice Address - Phone:321-951-9222
Practice Address - Fax:321-952-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U09682Medicare UPIN
22360ZMedicare ID - Type Unspecified