MEDICARE: LUKE ERIC STAUDENMAIER 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	3209	WI

General Provider Information

NPI Number	:	1093702920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE ERIC STAUDENMAIER D.C.

Provider Business Mailing Address
First Line	:	9570 WHITE STAR RD
Second Line	:
City	:	BRUSSELS
State	:	WI
Zip	:	54204-9781
Country	:	US
Telephone Number	:	920-825-7590
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N 18TH AVE
Second Line	:	SUITE #3
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-3207
Country	:	US
Telephone Number	:	920-743-7255
Fax Number	:	920-743-7256

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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