Individual
BRIAN WAYNE STUTZMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1580 W 4TH ST STE 103, MERIDIAN, ID 83642-2182
(208) 888-9292
(208) 888-3231
Mailing address
1580 W 4TH ST STE 103, MERIDIAN, ID 83642-2182
(208) 888-9292
(208) 888-3231
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-708
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029531
REGENCE BLUE SHIELD
ID
01
—
C708-5
BLUE CROSS
ID
Enumeration date
01/10/2007
Last updated
07/09/2007
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