Provider Demographics
NPI:1780748756
Name:STIERWALT, DENNY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DENNY
Middle Name:DAVID
Last Name:STIERWALT
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 1:1502 WEST KIMBERLY ROAD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5529
Mailing Address - Country:US
Mailing Address - Phone:563-386-2926
Mailing Address - Fax:563-386-2928
Practice Address - Street 1:1502 WEST KIMBERLY ROAD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5529
Practice Address - Country:US
Practice Address - Phone:563-386-2926
Practice Address - Fax:563-386-2928
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0026302Medicaid
02630Medicare ID - Type Unspecified