Provider Demographics
NPI:1255842373
Name:STITTLEBURG, TARYN LYNNE (DC)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:LYNNE
Last Name:STITTLEBURG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:LYNNE
Other - Last Name:STITTLEBURG-DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:234800 DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EDGAR
Mailing Address - State:WI
Mailing Address - Zip Code:54426
Mailing Address - Country:US
Mailing Address - Phone:952-564-3888
Mailing Address - Fax:952-945-9536
Practice Address - Street 1:234800 DEER CREEK LN
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426
Practice Address - Country:US
Practice Address - Phone:715-391-9671
Practice Address - Fax:952-945-9536
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor