Provider Demographics
NPI:1457362139
Name:STALDER, CESSALIE RICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:CESSALIE
Middle Name:RICHELLE
Last Name:STALDER
Suffix:
Gender:F
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 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-627-9151
Mailing Address - Fax:253-591-8892
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-627-9151
Practice Address - Fax:253-591-8892
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143239OtherSTATE L&I
WA8374217Medicaid
WA8930016OtherSTATE CRIME VICTIMS
WA0143240OtherSTATE L&I
WA8374217Medicaid
WA0143240OtherSTATE L&I
WAGAB18553Medicare PIN