Provider Demographics
NPI:1063430130
Name:STUETELBERG, DAVID B (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:STUETELBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DEL WEBB BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4354
Mailing Address - Country:US
Mailing Address - Phone:512-864-2880
Mailing Address - Fax:512-864-2411
Practice Address - Street 1:400 DEL WEBB BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4354
Practice Address - Country:US
Practice Address - Phone:512-864-2880
Practice Address - Fax:512-864-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T01161Medicare UPIN