Derek Wade Stickler, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6888 Issued in CO

Practice address

2447 S Prairie Ave
Pueblo, CO 81005-2886

Phone

(254) 394-0836

NPI assigned

Aug 17, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Longevity Chiropractic, LLC

  • Rehabilitation Chiropractor
  • Pueblo, CO
  • NPI 1174875298

  CO

  Medicare reassignment Authorized official
• Longevity Chiropractic

  • Chiropractor
  • Pueblo, CO
  • NPI 1376031302
  NPD (past) Authorized official

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1629326905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2447 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052886",
            "telephone_number": "254-394-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2447 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052886",
            "telephone_number": "254-394-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STICKLER",
        "first_name": "DEREK",
        "middle_name": "WADE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-17",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CO",
            "license": "6888",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "6888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine D Stewart, LCSW
• Lauren Stewart, RDH
• Rick S. Stewart, PHD
• Shirley Jo Stice, COTA
• Meghan S Stich, LCSW
• Krysta Stickler, D.C.
• Susan B Stiller, LCSW
• Lisa Stiner, RDH
• Richard M Stiphout, MD
• James R Stjernholm, M.D.

• Chiropractor in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Chiropractor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.