Provider Demographics
NPI:1023294170
Name:GARTZKE, STEPHEN M
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:GARTZKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 COMMERCE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3242
Mailing Address - Country:US
Mailing Address - Phone:715-425-9439
Mailing Address - Fax:715-629-7260
Practice Address - Street 1:1674 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3242
Practice Address - Country:US
Practice Address - Phone:715-425-9439
Practice Address - Fax:715-629-7260
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5031111N00000X
WI4624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor