Provider Demographics
NPI:1093702920
Name:STAUDENMAIER, LUKE ERIC (DC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ERIC
Last Name:STAUDENMAIER
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 1:9570 WHITE STAR RD
Mailing Address - Street 2:
Mailing Address - City:BRUSSELS
Mailing Address - State:WI
Mailing Address - Zip Code:54204-9781
Mailing Address - Country:US
Mailing Address - Phone:920-825-7590
Mailing Address - Fax:
Practice Address - Street 1:30 N 18TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3207
Practice Address - Country:US
Practice Address - Phone:920-743-7255
Practice Address - Fax:920-743-7256
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU53655Medicare UPIN