Provider Demographics
NPI:1336218346
Name:STUTMAN, MARK LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:STUTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:239 SOUTH BROADWAY
Mailing Address - Street 2:STUTMAN CHIROPRACTIC, P.C.
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231
Mailing Address - Country:US
Mailing Address - Phone:410-522-7446
Mailing Address - Fax:410-522-0071
Practice Address - Street 1:239 SOUTH BROADWAY
Practice Address - Street 2:STUTMAN CHIROPRACTIC, P.C.
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-522-7446
Practice Address - Fax:410-522-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5924790001Medicare NSC