Healthcare Provider Details

I. General information

NPI: 1023296654
Provider Name (Legal Business Name): STULL CHIROPRACTIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NILES RD
SAINT JOSEPH MI
49085-3355
US

IV. Provider business mailing address

2820 NILES RD
SAINT JOSEPH MI
49085-3355
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-1982
  • Fax:
Mailing address:
  • Phone: 269-429-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008480
License Number StateMI

VIII. Authorized Official

Name: DR. KATHLYNN STULL
Title or Position: DOCTOR / PRESIDENT
Credential: DC
Phone: 269-429-1982