Provider Demographics
NPI:1710088430
Name:STOLBA CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:STOLBA CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:STOLBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-794-7981
Mailing Address - Street 1:507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5503
Mailing Address - Country:US
Mailing Address - Phone:903-794-7981
Mailing Address - Fax:
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5503
Practice Address - Country:US
Practice Address - Phone:903-794-7981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1623111N00000X
TX9041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F123OtherPROVIDER #
AR5F123OtherGROUP #
TX0026HJOtherGROUP #
AR5X792OtherPROVIDER #
AR5F123OtherGROUP #
AR5F123Medicare ID - Type UnspecifiedGROUP#
TX00731RMedicare ID - Type UnspecifiedGROUP #
TX=========OtherTAX ID
AR5F123OtherGROUP #
AR5X792Medicare ID - Type UnspecifiedPROVIDER #
TX0026HJOtherGROUP #
TX8509N0Medicare ID - Type UnspecifiedPROVIDER#