Provider Demographics
NPI:1154300010
Name:STOIBER, PATRICK G (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:STOIBER
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 1:710 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4647
Mailing Address - Country:US
Mailing Address - Phone:715-424-8000
Mailing Address - Fax:715-424-8020
Practice Address - Street 1:710 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4647
Practice Address - Country:US
Practice Address - Phone:715-424-8000
Practice Address - Fax:715-424-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2349-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38847400Medicaid
WI38847400Medicaid
WIU22842Medicare UPIN