Healthcare Provider Details

I. General information

NPI: 1851319453
Provider Name (Legal Business Name): DARCI JILL STOTTS D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 KNICKERBOCKER RD.
SAN ANGELO TX
76904
US

IV. Provider business mailing address

3402 KNICKERBOCKER RD.
SAN ANGELO TX
76904
US

V. Phone/Fax

Practice location:
  • Phone: 325-949-8688
  • Fax:
Mailing address:
  • Phone: 325-949-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: