Provider Demographics
NPI:1316925084
Name:STOLTZ, GARY KENT (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:KENT
Last Name:STOLTZ
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 1:2105 PREVATT ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6131
Mailing Address - Country:US
Mailing Address - Phone:352-357-7955
Mailing Address - Fax:352-357-7254
Practice Address - Street 1:2105 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6131
Practice Address - Country:US
Practice Address - Phone:352-357-7955
Practice Address - Fax:352-357-7254
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89727OtherBLUE CROSS BLUE SHIELD
FL350053967OtherMEDICARE RAILROAD
FL380263900Medicaid
FLCH2081OtherWORK COMPENSATION
T56320Medicare UPIN
FLCH2081OtherWORK COMPENSATION