Provider Demographics
NPI:1770069932
Name:STIFFLER, JUSTIN RANDALL (L AC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RANDALL
Last Name:STIFFLER
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 E OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8052
Mailing Address - Country:US
Mailing Address - Phone:910-833-0766
Mailing Address - Fax:888-447-0823
Practice Address - Street 1:8517 E OAK ISLAND DR
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8052
Practice Address - Country:US
Practice Address - Phone:910-833-0766
Practice Address - Fax:888-447-0823
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist