Provider Demographics
NPI:1013070796
Name:STULL, DAVID A (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:STULL
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 1:101 HIGHWAY 47 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-9464
Mailing Address - Country:US
Mailing Address - Phone:205-225-1381
Mailing Address - Fax:
Practice Address - Street 1:101 HIGHWAY 47 S
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9464
Practice Address - Country:US
Practice Address - Phone:205-225-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGZPMedicare ID - Type UnspecifiedPROVIDER ID
GAU92423Medicare UPIN