Provider Demographics
NPI:1770593733
Name:STOLLER, CRAIG ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:STOLLER
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 1:203 S ZEEB RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8324
Mailing Address - Country:US
Mailing Address - Phone:734-274-5107
Mailing Address - Fax:734-661-4828
Practice Address - Street 1:2464E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4813
Practice Address - Country:US
Practice Address - Phone:734-418-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL567685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
J94223Medicare UPIN
MI0P30310 001Medicare ID - Type Unspecified