MEDICARE: ERICA MARIE STAEHLE 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	5159	OR

General Provider Information

NPI Number	:	1205269446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MARIE STAEHLE D.C.

Provider Business Mailing Address
First Line	:	628 NW YORK DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1572
Country	:	US
Telephone Number	:	541-388-2429
Fax Number	:	541-388-3429

Provider Business Practice Location Address
First Line	:	628 NW YORK DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-1572
Country	:	US
Telephone Number	:	541-388-2429
Fax Number	:	541-388-3429

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	11/28/2022

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