Provider Demographics
NPI:1538678024
Name:STULL, MATTHEW ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:STULL
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 1:10015 N AMBASSADOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1437
Mailing Address - Country:US
Mailing Address - Phone:816-237-7088
Mailing Address - Fax:
Practice Address - Street 1:10015 N AMBASSADOR DR STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1437
Practice Address - Country:US
Practice Address - Phone:816-237-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018034406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor