Provider Demographics
NPI:1669450300
Name:STOTZ, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:STOTZ
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 1:2507 FOX RUN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5318
Mailing Address - Country:US
Mailing Address - Phone:605-665-8073
Mailing Address - Fax:605-668-9653
Practice Address - Street 1:2507 FOX RUN PARKWAY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5318
Practice Address - Country:US
Practice Address - Phone:605-665-8073
Practice Address - Fax:605-668-9653
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994259OtherBCBS
NE46042364100Medicaid
SD7603150Medicaid
SDS100912Medicare PIN