Provider Demographics
NPI:1295012110
Name:PATRICK STOIBER CHIROPRACTIC INC.
Entity type:Organization
Organization Name:PATRICK STOIBER CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOIBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-424-8000
Mailing Address - Street 1:1720 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6907
Mailing Address - Country:US
Mailing Address - Phone:715-424-8000
Mailing Address - Fax:715-424-8020
Practice Address - Street 1:1720 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6907
Practice Address - Country:US
Practice Address - Phone:715-424-8000
Practice Address - Fax:715-424-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2349-012111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38847400Medicaid
WI38847400Medicaid