Provider Demographics
NPI:1043407901
Name:STUCKY CHIROPRACTIC PROADJUSTER OF LAKE HALLIE, SC
Entity type:Organization
Organization Name:STUCKY CHIROPRACTIC PROADJUSTER OF LAKE HALLIE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:STUCKY-LAGUARDIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-835-9514
Mailing Address - Street 1:3032 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-723-2892
Mailing Address - Fax:715-723-3594
Practice Address - Street 1:3032 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-723-2892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STUCKY CHIROPRACTIC CENTER, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-25
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty