Provider Demographics
NPI:1902178395
Name:J. MICHAEL STOLLEY, D.C., P.A.
Entity Type:Organization
Organization Name:J. MICHAEL STOLLEY, D.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-584-3386
Mailing Address - Street 1:12122 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2833
Mailing Address - Country:US
Mailing Address - Phone:727-584-3386
Mailing Address - Fax:727-581-8619
Practice Address - Street 1:12122 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2833
Practice Address - Country:US
Practice Address - Phone:727-584-3386
Practice Address - Fax:727-581-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3042261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88327Medicare UPIN