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General NPI Number Information
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NPI Number | 1912543059
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Entity Type | Organization
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Legal Business Name | STOLLER ENTERPRISE
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 113 S MAIN ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-6007
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Country | US
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Telephone | 567-224-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 913 EVERGREEN CIR
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City | WILLARD
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State | OH
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Zip | 44890-9742
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Country | US
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Telephone | 567-224-2209
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ZACHARY STOLLER
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Credential | D.C.
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Telephone | 567-224-2209
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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 |
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License Number State |
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