Provider Demographics
NPI:1881834620
Name:STAUFFACHER CORPORATION
Entity Type:Organization
Organization Name:STAUFFACHER CORPORATION
Other - Org Name:INTUN CHIROCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STAUFFACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-451-7077
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:920-784-7078
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:920-784-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty