Provider Demographics
NPI:1821050030
Name:STAUFFACHER, RENEE A (DC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:STAUFFACHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 WILGUS AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3045
Mailing Address - Country:US
Mailing Address - Phone:920-451-7077
Mailing Address - Fax:920-451-1400
Practice Address - Street 1:3144 WILGUS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3045
Practice Address - Country:US
Practice Address - Phone:920-451-7077
Practice Address - Fax:920-451-1400
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556384111N00000X
PADC009774111N00000X
PAAJ009579111N00000X
WI4357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor