Active NPI
John David Stader, D.C.
- Sports Physician Chiropractor
- Bettendorf, IA
National Provider Identifier
1679592133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 06575
- Practice address
- 2400 18TH St
Suite 101
Bettendorf, IA 52722-3280 - Phone
- (563) 355-2020
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 06575 | IA | Primary |
Addresses
Primary practice location
2400 18TH St
Suite 101
Bettendorf, IA 52722-3280
Mailing address
3731 Eldorado Dr
Bettendorf, IA 52722-2601
Phone (563) 355-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34148 | Other | IA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041123000845 | IA | Practitioner - Chiropractic | 6608831250 | Practice locations: Bettendorf, IA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2415 18TH St
Suite 201
Bettendorf, IA 52722-3280
2415 18TH St
Suite 201
Bettendorf, IA 52722-3281
Phone (563) 355-2020
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679592133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3731 ELDORADO DR",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527222601",
"telephone_number": "563-355-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 18TH ST",
"address_2": "SUITE 101",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527223280",
"telephone_number": "563-355-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STADER",
"first_name": "JOHN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "IA",
"license": "06575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "34148",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bettendorf, IA
- Spartans Hub LLC
- Louise M Speer, LMHC
- Amy M Spellerberg Massie, LISW
- Spinal Destination PLC (Holli Martin DC)
- Stephanie Spinler Spinler, CD
- Kate Stamer, ARNP
- State Street Women's Health Center
- State University of Iowa (UI Health Care Urgent Care Bettendorf)
- State University of Iowa (University of Iowa Health Care-Quad Cities)
- David B Staub, M.D.
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.
- 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.