Active NPI
Stacey Matern, D.C.
- Chiropractor
- Ham Lake, MN
National Provider Identifier
1407294846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5811
- Practice address
- 1444 147TH Ave NE
Suite 250
Ham Lake, MN 55304-4971 - Phone
- (763) 208-5382
- Fax
- (763) 208-2911
- NPI assigned
- Jun 7, 2013
- Last updated
- Jun 11, 2013
- Sex
- Female
- 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 | 5811 | MN | Primary |
Addresses
Primary practice location
1444 147TH Ave NE
Suite 250
Ham Lake, MN 55304-4971
Mailing address
4741 Regent Ave N
Crystal, MN 55429-3740
Phone (651) 341-9194
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 |
|---|---|---|---|
| 5811 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Exceptional Chiropractic P a | Chiropractor | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Ham Lake, MN
- NPI 1881795961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1407294846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4741 REGENT AVE N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554293740",
"telephone_number": "651-341-9194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1444 147TH AVE NE",
"address_2": "SUITE 250",
"city": "HAM LAKE",
"state": "MN",
"postal_code": "553044971",
"telephone_number": "763-208-5382",
"fax_number": "763-208-2911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATERN",
"first_name": "STACEY",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-07",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "5811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ham Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.