Healthcare Provider Details

I. General information

NPI: 1619088820
Provider Name (Legal Business Name): MICHAEL VERNON STOTLER D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 PULASKI HWY SUITE 203
JOPPA MD
21085-3610
US

IV. Provider business mailing address

PO BOX 260
FALLSTON MD
21047-0260
US

V. Phone/Fax

Practice location:
  • Phone: 410-679-8258
  • Fax: 410-679-2681
Mailing address:
  • Phone: 410-879-9013
  • Fax: 410-879-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS02082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: