Provider Demographics
NPI:1790926061
Name:STOTLER CHIROPRACTIC
Entity Type:Organization
Organization Name:STOTLER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-679-8258
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-0260
Mailing Address - Country:US
Mailing Address - Phone:410-879-9013
Mailing Address - Fax:410-879-9015
Practice Address - Street 1:413 PULASKI HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3610
Practice Address - Country:US
Practice Address - Phone:410-679-8258
Practice Address - Fax:410-679-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD902082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV02374Medicare UPIN