Provider Demographics
NPI:1700877594
Name:STUCKY-LAGUARDIA, PAMELA J (DC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:STUCKY-LAGUARDIA
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 1:2105 E CLAIREMONT AVE
Mailing Address - Street 2:STUCKY CHIROPRACTIC CENTER SC
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-835-9514
Mailing Address - Fax:715-835-2602
Practice Address - Street 1:2105 E CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-835-9514
Practice Address - Fax:715-835-2602
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38847800Medicaid
WI38847800Medicaid
U01292Medicare UPIN