Healthcare Provider Details

I. General information

NPI: 1861311151
Provider Name (Legal Business Name): DENNIS STOLYAROV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16573 VENTURA BLVD STE 5
ENCINO CA
91436-2021
US

IV. Provider business mailing address

17106 CLEMONS DR
ENCINO CA
91436-4026
US

V. Phone/Fax

Practice location:
  • Phone: 818-421-2884
  • Fax:
Mailing address:
  • Phone: 818-421-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: