MEDICARE: DR. DOUGLAS CORNELIUS STONE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301003092	MI

General Provider Information

NPI Number	:	1164506747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS CORNELIUS STONE DC

Provider Business Mailing Address
First Line	:	9001 MILLER RD STE 4
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1115
Country	:	US
Telephone Number	:	810-635-8428
Fax Number	:	810-635-4626

Provider Business Practice Location Address
First Line	:	9001 MILLER RD STE 4
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1115
Country	:	US
Telephone Number	:	810-635-8428
Fax Number	:	810-635-4626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	11/05/2021

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