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General NPI Number Information
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NPI Number | 1659844090
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Entity Type | Individual
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Provider Name | GERALD L STOLARCZYK DOM
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Gender | Male
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 417 UNIVERSITY ST STE 1
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City | TRINIDAD
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State | CO
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Zip | 81082-2560
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Country | US
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Telephone | 505-506-1230
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Fax | 719-846-6297
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Provider Business Mailing Address
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Address Line | 629 PECOS AVE
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City | RATON
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State | NM
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Zip | 87740-4158
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Country | US
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Telephone | 505-506-1230
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Fax | 719-846-2941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | DOM1249
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0002462
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License Number State | CO
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