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General NPI Number Information
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NPI Number | 1164690806
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Entity Type | Organization
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Legal Business Name | RICHARD P. STORK D.C. PLLC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1549 N LEROY ST STE. B
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City | FENTON
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State | MI
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Zip | 48430-2790
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Country | US
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Telephone | 810-629-2757
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Fax | 810-629-3899
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Provider Business Mailing Address
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Address Line | 1549 N LEROY ST STE. B
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City | FENTON
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State | MI
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Zip | 48430-2790
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Country | US
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Telephone | 810-629-2757
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Fax | 810-629-3899
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD P STORK
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Credential | D.C.
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Telephone | 810-629-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009378
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License Number State | MI
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