Provider Demographics
NPI:1932118346
Name:STALDER, ROBERT ANTON (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTON
Last Name:STALDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-593-8449
Mailing Address - Fax:253-502-5977
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 110
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-593-8449
Practice Address - Fax:253-502-5977
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA143241OtherL & I
WA8374191Medicaid
WA143076OtherL & I
WA8930017OtherCRIME VICTIMS
AB18550Medicare ID - Type Unspecified
WA8930017OtherCRIME VICTIMS
WAGAB18551Medicare PIN
WAGAB18550Medicare PIN