Provider Demographics
NPI:1700987336
Name:STULL, JOHN K (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
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 1:2224 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1370
Mailing Address - Country:US
Mailing Address - Phone:937-259-8850
Mailing Address - Fax:937-259-8224
Practice Address - Street 1:2224 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1370
Practice Address - Country:US
Practice Address - Phone:937-259-8850
Practice Address - Fax:937-259-8224
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2147608Medicaid
OHST0817863Medicare UPIN