Provider Demographics
NPI:1548850316
Name:STOLARCZYK, CALEB JOZEF (DOM)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JOZEF
Last Name:STOLARCZYK
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PECOS AVE
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4158
Mailing Address - Country:US
Mailing Address - Phone:575-779-5888
Mailing Address - Fax:
Practice Address - Street 1:629 PECOS AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4158
Practice Address - Country:US
Practice Address - Phone:575-779-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDOM1269OtherLICENSE