Provider Demographics
NPI:1760563944
Name:STENDER ORTHOPEDIC AND CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:STENDER ORTHOPEDIC AND CHIROPRACTIC CLINIC INC
Other - Org Name:WOLTER CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-835-1122
Mailing Address - Street 1:824 SOUTH HASTINGS WAY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-835-1122
Mailing Address - Fax:715-835-0807
Practice Address - Street 1:824 S HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3426
Practice Address - Country:US
Practice Address - Phone:715-835-1122
Practice Address - Fax:715-835-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3733-012111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIW09917Medicare UPIN
WI70660Medicare PIN