Provider Demographics
NPI:1710003934
Name:STANGL, MARIE ROSE
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ROSE
Last Name:STANGL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 SINSINAWA RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53811-9704
Mailing Address - Country:US
Mailing Address - Phone:608-748-4392
Mailing Address - Fax:
Practice Address - Street 1:4655 OLD HIGHWAY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9630
Practice Address - Country:US
Practice Address - Phone:563-588-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38797OtherBLUE CROSS
IAV05074Medicare UPIN
IAI15188Medicare ID - Type Unspecified