Provider Demographics
NPI:1972893105
Name:STALHEIM, CONRAD (DC)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:
Last Name:STALHEIM
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 1:410 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2406
Mailing Address - Country:US
Mailing Address - Phone:319-351-9460
Mailing Address - Fax:
Practice Address - Street 1:410 1ST AVE
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2406
Practice Address - Country:US
Practice Address - Phone:319-351-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor