Individual provider Active NPI

Renee A Stauffacher, DC

  • Chiropractor
  • Sheboygan, WI
National Provider Identifier
1821050030
Registry record updated Mar 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
AJ009579 Issued in PA
Practice address
3144 Wilgus Ave
Sheboygan, WI 53081-3045
Phone
(920) 451-7077
Fax
(920) 451-1400
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104556384 VA
Chiropractor 111N00000X DC009774 PA
Chiropractor 111N00000X AJ009579 PA Primary
Chiropractor 111N00000X 4357 WI

Addresses

Primary practice location

3144 Wilgus Ave
Sheboygan, WI 53081-3045

Mailing address

3144 Wilgus Ave
Sheboygan, WI 53081-3045
Phone (920) 451-7077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080108000799 WI Practitioner - Chiropractic 7618997776

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AJ009579PAMDChiropractor
4357WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stauffacher Corporation Chiropractor CurrentSince Mar 2, 2009 Accepting new patients
Virginia Wellness Associates Inc. Chiropractor Past Accepting new patients
Chester Family Chiropractic Center P C Chiropractor PastSince Sep 4, 1991 Accepting new patients
Dirker Chiropractic LLC Chiropractor PastSince Sep 29, 2003 Accepting new patients

Locations

3144 Wilgus Ave
Sheboygan, WI 53081
Phone (920) 451-1400

1407 N 8th St
Ste 102
Sheboygan, WI 53081
Phone (920) 451-7077

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235952000000",
    "number": "1821050030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3144 WILGUS AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813045",
            "telephone_number": "920-451-7077",
            "fax_number": "920-451-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3144 WILGUS AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813045",
            "telephone_number": "920-451-7077",
            "fax_number": "920-451-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUFFACHER",
        "first_name": "RENEE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2009-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556384",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009774",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "AJ009579",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4357",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.