MEDICARE: DR. JAMES ROBERT STALLBAUMER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0105788	KS

General Provider Information

NPI Number	:	1043664667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ROBERT STALLBAUMER D.C.

Provider Business Mailing Address
First Line	:	1018 160TH RD
Second Line	:
City	:	SENECA
State	:	KS
Zip	:	66538-2176
Country	:	US
Telephone Number	:	785-294-0884
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 S 1ST ST
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-2618
Country	:	US
Telephone Number	:	785-742-7164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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