Healthcare Provider Details

I. General information

NPI: 1346212149
Provider Name (Legal Business Name): PAUL F. STOETZEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 WALTER ST SUITE C
LEMONT IL
60439-2903
US

IV. Provider business mailing address

1243 STATE ST STE 106B
LEMONT IL
60439-4402
US

V. Phone/Fax

Practice location:
  • Phone: 630-257-8700
  • Fax: 630-257-1376
Mailing address:
  • Phone: 630-988-8787
  • Fax: 630-257-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: