Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 013177 | NY |
N | 111NR0400X | Rehabilitation Chiropractor | 013177 | NY |
Y | 111NS0005X | Chiropractic Sports Physician | 013177 | NY |
N | 111NX0100X | Occupational Health | 013177 | NY |
NPI | 1902376536 |
---|---|
Provider Name | Dr. Shane Michael Stadtmueller |
First Address | Williamsville, NY 14221 |
Second Address | Williamsville, NY 14221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |