Healthcare Provider Details

I. General information

NPI: 1750171021
Provider Name (Legal Business Name): NEIL BRANDAN STARK DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RALEY BLVD STE 100
CHICO CA
95928-8347
US

IV. Provider business mailing address

PO BOX 2802
BELLINGHAM WA
98227-2802
US

V. Phone/Fax

Practice location:
  • Phone: 530-514-0904
  • Fax:
Mailing address:
  • Phone: 530-514-0904
  • Fax: 866-493-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEIL BRANDAN STARK
Title or Position: OWNER
Credential:
Phone: 530-514-0904