Provider Demographics
NPI:1083486617
Name:STUECK, ISSABELLA VERONICA (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:ISSABELLA
Middle Name:VERONICA
Last Name:STUECK
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8573 CLOVERLEAF LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-8510
Mailing Address - Country:US
Mailing Address - Phone:715-250-3500
Mailing Address - Fax:
Practice Address - Street 1:645 W RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1254
Practice Address - Country:US
Practice Address - Phone:920-997-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6129-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor