Active NPI
Brian Wayne Stutzman, D.C.
- Chiropractor
- Meridian, ID
National Provider Identifier
1033268545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIA-708
- Practice address
- 1580 W 4TH St Ste 103
Meridian, ID 83642-2182 - Phone
- (208) 888-9292
- Fax
- (208) 888-3231
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIA-708 | ID | Primary |
Addresses
Primary practice location
1580 W 4TH St Ste 103
Meridian, ID 83642-2182
Mailing address
1580 W 4TH St Ste 103
Meridian, ID 83642-2182
Phone (208) 888-9292
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C708-5 | Other | ID | BLUE CROSS |
| 000010029531 | Other | ID | REGENCE BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-708 | ID | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1033268545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1580 W 4TH ST STE 103",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836422182",
"telephone_number": "208-888-9292",
"fax_number": "208-888-3231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 W 4TH ST STE 103",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836422182",
"telephone_number": "208-888-9292",
"fax_number": "208-888-3231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUTZMAN",
"first_name": "BRIAN",
"middle_name": "WAYNE",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "CHIA-708",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "C708-5",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010029531",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.