Healthcare Provider Details

I. General information

NPI: 1164506747
Provider Name (Legal Business Name): DOUGLAS CORNELIUS STONE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/05/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 MILLER RD STE 4
SWARTZ CREEK MI
48473-1115
US

IV. Provider business mailing address

9001 MILLER RD STE 4
SWARTZ CREEK MI
48473-1115
US

V. Phone/Fax

Practice location:
  • Phone: 810-635-8428
  • Fax: 810-635-4626
Mailing address:
  • Phone: 810-635-8428
  • Fax: 810-635-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301003092
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: