Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2301010654 | MI |
NPI | 1265926752 |
---|---|
Provider Name | Dr. Sydney Stanul |
First Address | Jenison, MI 49428-9565 |
Second Address | Jenison, MI 49428-9565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |