MEDICARE: STRATFORD CHIROPRACTIC CLINIC

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	3065	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376687913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATFORD CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	223 NORTH 3 AVENUE
Second Line	:	SUITE D
City	:	STRATFORD
State	:	WI
Zip	:	54484
Country	:	US
Telephone Number	:	715-687-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 NORTH 3RD AVENUE
Second Line	:	SUITE D
City	:	STRATFORD
State	:	WI
Zip	:	54484
Country	:	US
Telephone Number	:	715-687-3400
Fax Number	:

Authorized Official
Title or Position	:	DC OWNER
Name	:	CARMEN LOUISE QUEDNOW
Credential	:	DC
Telephone Number	:	715-687-3400

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	06/30/2008

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