Provider Demographics
NPI:1053535963
Name:STULTZ, MICHAEL O (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:STULTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 WILLOW CREEK RD STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1610
Mailing Address - Country:US
Mailing Address - Phone:928-778-6200
Mailing Address - Fax:
Practice Address - Street 1:1024 WILLOW CREEK RD STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1610
Practice Address - Country:US
Practice Address - Phone:928-778-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ123244OtherPTAN