Healthcare Provider Details

I. General information

NPI: 1114134483
Provider Name (Legal Business Name): PAUL ROBERT STILES CHIROPRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43269 GRAND RIVER AVE
NOVI MI
48375-1737
US

IV. Provider business mailing address

43269 GRAND RIVER AVE
NOVI MI
48375-1737
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-5170
  • Fax: 248-349-1997
Mailing address:
  • Phone: 248-349-5170
  • Fax: 248-349-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberPS007285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: