MEDICARE: DR. INSON STOLTZ 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	8925	TX

General Provider Information

NPI Number	:	1952458200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INSON STOLTZ DC

Provider Business Mailing Address
First Line	:	1504 PENNSYLVANIA AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-335-4878
Fax Number	:	817-335-4890

Provider Business Practice Location Address
First Line	:	1504 PENNSYLVANIA AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2027
Country	:	US
Telephone Number	:	817-335-4878
Fax Number	:	817-335-4890

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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