Stacy Lane Hallgren, D.C., C.C.E.P., CST

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

798 Issued in ND

Practice address

4350 S Washington St
Suite 100
Grand Forks, ND 58201-7184

Phone

(701) 732-2888

Fax

(701) 732-2711

NPI assigned

Nov 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Performance Chiropractic PLLCGroup PAC ID 3779651336, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Performance Chiropractic PLLC

  • Chiropractor
  • Grand Forks, ND
  • NPI 1720237258
  Medicare reassignment Care Compare group NPD Authorized official
• Brian V Jongeward

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1407909120

  Chiropractor

  NPD (past)

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219190400000",
    "number": "1407036627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 22ND ST NE",
            "city": "EMERADO",
            "state": "ND",
            "postal_code": "582289788",
            "telephone_number": "701-594-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 S WASHINGTON ST",
            "address_2": "SUITE 100",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017184",
            "telephone_number": "701-732-2888",
            "fax_number": "701-732-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLGREN",
        "first_name": "STACY",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "D.C., C.C.E.P., CST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-05",
        "last_updated": "2008-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407036627",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14609",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "713023",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitchell Hall, DPT
• Ryan Hall, PA-C
• Shyleen Hall, MD
• Shannon C Hallahan
• Alyssa Halley
• Joseph Hallock
• Brandon M Hallquist, PHARM D
• Gail Rae Halverson, N.P.
• Larry O Halvorson, MD
• Tyna Marie Halvorson, LPN

• All providers in Grand Forks, ND
• Chiropractor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; 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.