Provider Demographics
NPI:1447288154
Name:STULC, ERIC N (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:N
Last Name:STULC
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 1:602 'I' STREET
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350
Mailing Address - Country:US
Mailing Address - Phone:219-325-0441
Mailing Address - Fax:219-325-0549
Practice Address - Street 1:602 'I' STREET
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-325-0441
Practice Address - Fax:219-325-0549
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001662111N00000X
IN08001662A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200113870AMedicaid
IN200113870Medicaid
IN200113870Medicaid
IN200113870AMedicaid