Provider Demographics
NPI:1720387053
Name:STOLP, GALEN RICHARD (DC)
Entity Type:Individual
Prefix:MR
First Name:GALEN
Middle Name:RICHARD
Last Name:STOLP
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 1:2401 W. 50TH ST.
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-368-0195
Mailing Address - Fax:605-534-7022
Practice Address - Street 1:2401 W. 50TH ST.
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-368-0195
Practice Address - Fax:605-534-7022
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor