Provider Demographics
NPI:1841251931
Name:STITZEL, CLAYTON J
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:J
Last Name:STITZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8753
Mailing Address - Country:US
Mailing Address - Phone:717-627-3009
Mailing Address - Fax:717-627-3330
Practice Address - Street 1:504 W ORANGE ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8753
Practice Address - Country:US
Practice Address - Phone:717-627-3009
Practice Address - Fax:717-627-3330
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008875111N00000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU92299Medicare UPIN
PA063488Medicare ID - Type UnspecifiedMEDICARE