Healthcare Provider Details

I. General information

NPI: 1760563944
Provider Name (Legal Business Name): STENDER ORTHOPEDIC AND CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S HASTINGS WAY
EAU CLAIRE WI
54701-3426
US

IV. Provider business mailing address

824 SOUTH HASTINGS WAY
EAU CLAIRE WI
54701
US

V. Phone/Fax

Practice location:
  • Phone: 715-835-1122
  • Fax: 715-835-0807
Mailing address:
  • Phone: 715-835-1122
  • Fax: 715-835-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number3733-012
License Number StateWI

VIII. Authorized Official

Name: JEREMY PAUL STENDER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 715-835-1122