Individual provider Active NPI

Mark E Stuckey, D.C.

  • Chiropractor
  • O Fallon, MO
National Provider Identifier
1386692234
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
MO005338 Issued in MO
Practice address
109 Church St
O Fallon, MO 63366-2894
Phone
(636) 240-2225
Fax
(636) 281-5377
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X MO005338 MO Primary

Addresses

Primary practice location

109 Church St
O Fallon, MO 63366-2894

Mailing address

109 Church St
O Fallon, MO 63366-2894
Phone (636) 240-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080627000056 MO Practitioner - Chiropractic 3375615958 Receives reassigned benefits from 2 practitioners
Practice locations: O Fallon, MO

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MO005338MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
No Limits Chiropractic Chiropractor CurrentSince Jan 1, 1990 Accepting new patients

Locations

109 Church St
O Fallon, MO 63366
Phone (636) 240-2225

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1386692234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CHURCH ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662894",
            "telephone_number": "636-240-2225",
            "fax_number": "636-281-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CHURCH ST",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633662894",
            "telephone_number": "636-240-2225",
            "fax_number": "636-281-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKEY",
        "first_name": "MARK",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "MO005338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.