Provider Demographics
NPI:1962657700
Name:ROTTIER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROTTIER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-254-0233
Mailing Address - Street 1:1265 MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2884
Mailing Address - Country:US
Mailing Address - Phone:715-254-0233
Mailing Address - Fax:
Practice Address - Street 1:1265 MAIN ST
Practice Address - Street 2:STE 103
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2884
Practice Address - Country:US
Practice Address - Phone:715-254-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35214Medicare PIN
WIU62638Medicare UPIN