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NPI Code Detail

MEDICARE: DR. KEVIN LANCE STALLS DC

MEDICARE:  DR. KEVIN LANCE STALLS  DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCHIR009997GA

General Provider Information

NPI Number : 1154839769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN LANCE STALLS DC
Provider Business Mailing Address
First Line : 1234 DEFOOR VILLAGE CT NW APT 307
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2990
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 NORTHSIDE DR NW STE A3
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2695
Country : US
Telephone Number : 404-351-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2018
Last Update Date : 01/17/2018

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Directions to “ DR. KEVIN LANCE STALLS DC” Practice Location

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