Provider Demographics
NPI:1942307913
Name:STOLBA, MICHAEL DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DALE
Last Name:STOLBA
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 1:507 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:903-792-0288
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:903-792-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9041111N00000X
AR1623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2413OtherBC/BS PROVIDER #
AR5F123OtherBC/BS AR GROUP #
TX0026HJOtherBC/BS GROUP #
AR5X792OtherBC/BS AR PROVIDER #
TXU78168Medicare UPIN
AR5F123Medicare ID - Type UnspecifiedGROUP #
AR5F123OtherBC/BS AR GROUP #
TXCH9888Medicare ID - Type UnspecifiedMEDICARE RAILROAD GRP #
TX8509NOMedicare ID - Type UnspecifiedPROVIDER #
TX00731RMedicare ID - Type UnspecifiedGROUP #
TX8F2413OtherBC/BS PROVIDER #
AR5F123Medicare ID - Type UnspecifiedGRP #