Provider Demographics
NPI:1962711598
Name:STIFTER, GILES FRANCIS (DC, CCWP)
Entity type:Individual
Prefix:DR
First Name:GILES
Middle Name:FRANCIS
Last Name:STIFTER
Suffix:
Gender:M
Credentials:DC, CCWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 57TH AVE NE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-9775
Mailing Address - Country:US
Mailing Address - Phone:763-515-6177
Mailing Address - Fax:763-515-6199
Practice Address - Street 1:10904 57TH AVE NE
Practice Address - Street 2:SUITE 107
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-9775
Practice Address - Country:US
Practice Address - Phone:763-515-6177
Practice Address - Fax:763-515-6199
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor