Active NPI
Roberta Ann Stack, D.C.
- Chiropractor
- Waltham, MA
National Provider Identifier
1588711766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH 706
- Practice address
- 42 Weston St
Suite 1
Waltham, MA 02453-7756 - Phone
- (781) 891-1722
- NPI assigned
- Jan 3, 2007
- 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 | CH 706 | MA | Primary |
Addresses
Primary practice location
42 Weston St
Suite 1
Waltham, MA 02453-7756
Mailing address
42 Weston St
Suite 1
Waltham, MA 02453-7756
Phone (781) 891-1722
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y35525 | Other | MA | BCBSMA |
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 |
|---|---|---|---|
| CH 706 | MA | MD | Chiropractor |
| 706 | MA | MD | Rehabilitation Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588711766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 WESTON ST",
"address_2": "SUITE 1",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024537756",
"telephone_number": "781-891-1722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 WESTON ST",
"address_2": "SUITE 1",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024537756",
"telephone_number": "781-891-1722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "ROBERTA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "CH 706",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSMA",
"identifier": "Y35525",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.