Provider Demographics
NPI:1437634334
Name:STADLER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:STADLER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-364-8488
Mailing Address - Street 1:711 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1507
Mailing Address - Country:US
Mailing Address - Phone:252-232-7910
Mailing Address - Fax:
Practice Address - Street 1:711 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1507
Practice Address - Country:US
Practice Address - Phone:252-232-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023323789Medicaid