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General NPI Number Information
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NPI Number | 1437331618
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR DYNAMIC LIVING INC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 1528 NW 5TH ST SUITE 100
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City | RICHMOND
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State | IN
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Zip | 47374-1844
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Country | US
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Telephone | 765-935-0070
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Fax | 765-935-0073
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Provider Business Mailing Address
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Address Line | 1528 NW 5TH ST SUITE 100
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City | RICHMOND
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State | IN
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Zip | 47374-1844
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Country | US
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Telephone | 765-935-0070
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Fax | 765-935-0073
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Authorized Official
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Title or Position | CEO
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Name | DR. STEVEN EDWARD STOLLER
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Credential | M.D.
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Telephone | 765-935-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10024995A
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License Number State | IN
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