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General NPI Number Information
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NPI Number | 1679592133
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Entity Type | Individual
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Provider Name | JOHN DAVID STADER D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 18TH ST SUITE 101
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City | BETTENDORF
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State | IA
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Zip | 52722-3280
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Country | US
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Telephone | 563-355-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 ELDORADO DR
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City | BETTENDORF
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State | IA
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Zip | 52722-2601
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Country | US
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Telephone | 563-355-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 06575
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License Number State | IA
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