Provider Demographics
NPI:1063712305
Name:STAULA, KRISTEN L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:L
Last Name:STAULA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:HANLON STAULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:31 VILLAGE WEST TRL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7501
Mailing Address - Country:US
Mailing Address - Phone:603-661-0101
Mailing Address - Fax:
Practice Address - Street 1:250 COPELAND ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4073
Practice Address - Country:US
Practice Address - Phone:617-328-0839
Practice Address - Fax:617-328-8885
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0027693Medicare PIN