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General NPI Number Information
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NPI Number | 1871620310
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Entity Type | Organization
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Legal Business Name | STAFFORD CHIROPRACTIC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 3333 S SUNNYSLOPE RD 108
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City | NEW BERLIN
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State | WI
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Zip | 53151-4502
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Country | US
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Telephone | 262-785-1811
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Fax | 262-785-9887
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Provider Business Mailing Address
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Address Line | PO BOX 510444
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City | NEW BERLIN
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State | WI
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Zip | 53151-0444
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Country | US
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Telephone | 262-785-1811
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Fax | 262-785-9887
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Authorized Official
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Title or Position | CHIROPRACTOR OWNER
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Name | DR. MICHELLE STAFFORD
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Credential | D.C.
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Telephone | 262-785-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3258
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License Number State | WI
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