Provider Demographics
NPI:1700838851
Name:STALHEIM CHIROPRACTIC SC
Entity Type:Organization
Organization Name:STALHEIM CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STALHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-735-9824
Mailing Address - Street 1:604 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1064
Mailing Address - Country:US
Mailing Address - Phone:715-735-9824
Mailing Address - Fax:
Practice Address - Street 1:604 COUNTY ROAD T
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1064
Practice Address - Country:US
Practice Address - Phone:715-735-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty