Stacy Mae Chilton, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH60106639 Issued in WA

Practice address

811 11TH Ave
Longview, WA 98632-2462

Phone

(360) 423-3482

NPI assigned

Dec 29, 2009

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 names 1

• Stacy Mae Bundrock Former name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416960000000",
    "number": "1629308531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322462",
            "telephone_number": "360-423-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322462",
            "telephone_number": "360-423-3482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILTON",
        "first_name": "STACY",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-29",
        "last_updated": "2014-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60106639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "BUNDROCK",
            "middle_name": "MAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Child and Adolescent Clinic
• Alyssa Nicole Childers
• Athenia Childers, BS, MSCJO, QMPH - R
• Brandi Marie Childers, LMP
• Anthony Ryan Chilton, DC
• Emily Chiongson, RD
• Jesse Cho
• Stephen M Choate, RPH.
• Myelin Choice
• Ke Xin Chong, CT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.