Provider Demographics
NPI:1265611081
Name:STOETZEL'S PLANET CHIROPRACTIC LTD
Entity type:Organization
Organization Name:STOETZEL'S PLANET CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:STOETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-257-8700
Mailing Address - Street 1:1192 WALTER ST
Mailing Address - Street 2:STE C
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2903
Mailing Address - Country:US
Mailing Address - Phone:630-257-8700
Mailing Address - Fax:630-257-1376
Practice Address - Street 1:1192 WALTER ST
Practice Address - Street 2:STE C
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2903
Practice Address - Country:US
Practice Address - Phone:630-257-8700
Practice Address - Fax:630-257-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU81148Medicare UPIN