Individual
DR. CHARLENE R STODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
1025 W IRONWOOD DR, STE 2, COEUR D ALENE, ID 83814-3161
(208) 667-0875
(208) 667-2850
Mailing address
1025 W IRONWOOD DR, STE 2, COEUR D ALENE, ID 83814-3161
(208) 667-0875
(208) 667-2850
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-819
ID
111NS0005X
Sports Physician Chiropractor
CHIA819
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010022440
BLUE SHIELD
ID
05
—
1673575
—
ID
01
—
C-8190
BLUE CROSS
ID
Enumeration date
06/20/2005
Last updated
07/12/2023
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