Provider Demographics
NPI:1104092097
Name:STELLMACHER, RONALD L (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:STELLMACHER
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 1:1121 N BADGER AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3249
Mailing Address - Country:US
Mailing Address - Phone:920-738-7474
Mailing Address - Fax:920-738-7485
Practice Address - Street 1:1121 N BADGER AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3249
Practice Address - Country:US
Practice Address - Phone:920-738-7474
Practice Address - Fax:920-738-7485
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2201111N00000X
NYX009815-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63414Medicare UPIN
WI000075871Medicare PIN