Stefan Richard Black, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00034220 Issued in WA

Practice address

15100 SE 38TH St
305B
Bellevue, WA 98006

Phone

(425) 289-0092

Fax

(425) 289-0095

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Stefan Black DC LLC

  • Chiropractor
  • Seattle, WA
  • NPI 1801156179
  Medicare reassignment NPD Authorized official
• Wellnessone of Eastgate, PS

  • Health Service Clinic/Center
  • Bellevue, WA
  • NPI 1750653374
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336694400000",
    "number": "1114082401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15100 SE 38TH ST",
            "address_2": "305B",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98006",
            "telephone_number": "425-289-0092",
            "fax_number": "425-289-0095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15100 SE 38TH ST",
            "address_2": "305B",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98006",
            "telephone_number": "425-289-0092",
            "fax_number": "425-289-0095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "STEFAN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2012-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Birth N More
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• Nishall Irene Bisi Gutierrez, HIS
• Brenna Rae Bittner, MA60663284
• Robert Lee Bjurstrom, M.D.
• Blackrock Services Inc
• Ethan Jon Blackstone, MFTA
• Tara Chelan Blahm
• Joelle Blair
• Linda Unruh Blakely, M.D.

• Chiropractor in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.