Provider Demographics
NPI:1972699619
Name:STAUFFER, DENNEAL RENE (D C)
Entity Type:Individual
Prefix:DR
First Name:DENNEAL
Middle Name:RENE
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S 56TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3960
Mailing Address - Country:US
Mailing Address - Phone:402-488-8801
Mailing Address - Fax:402-488-8801
Practice Address - Street 1:735 S 56TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3960
Practice Address - Country:US
Practice Address - Phone:402-488-8801
Practice Address - Fax:402-488-8801
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91185989100Medicaid
NE36673OtherBLUE CROSS BLUE SHIELD
NE269309STMedicare ID - Type Unspecified
NE36673OtherBLUE CROSS BLUE SHIELD