Provider Demographics
NPI:1154434017
Name:STADELMAN, PETER N (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
Last Name:STADELMAN
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 1:10822 NE 2ND PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5832
Mailing Address - Country:US
Mailing Address - Phone:425-453-0222
Mailing Address - Fax:425-453-0224
Practice Address - Street 1:10822 NE 2ND PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5832
Practice Address - Country:US
Practice Address - Phone:425-453-0222
Practice Address - Fax:425-453-0224
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU64296Medicare UPIN
WAGAB15819Medicare ID - Type Unspecified