Provider Demographics
NPI:1184824476
Name:STULL, KATHLYNN JON (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLYNN
Middle Name:JON
Last Name:STULL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3355
Mailing Address - Country:US
Mailing Address - Phone:269-429-1982
Mailing Address - Fax:269-556-9615
Practice Address - Street 1:2820 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3355
Practice Address - Country:US
Practice Address - Phone:269-429-1982
Practice Address - Fax:269-556-9615
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A111580OtherBCBSMI
950A111370OtherBLUE CROSS BLUE SHIELD OF
MI950A111580OtherBCBSMI