Stacey Ann Clark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

006-0001158 Issued in VT

Practice address

11 Hill St
Lyndonville, VT 05851-8911

Phone

(802) 626-5866

Fax

(802) 626-0980

NPI assigned

Mar 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lyndonville Family Chiropractic, Inc.Group PAC ID 8224090881, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lyndonville Family Chiropractic, Inc.

  • Chiropractor
  • Lyndonville, VT
  • NPI 1326254657
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699891580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 EAST ST",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "058518628",
            "telephone_number": "802-626-4218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 HILL ST",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "058518911",
            "telephone_number": "802-626-5866",
            "fax_number": "802-626-0980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STACEY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "006-0001158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Richard Breton, PT,MPT,OCS,CSCS
• Terry Bunnell, BA
• Ken M. Burchesky, DDS
• Ron Caric, DDS
• Karson Ellsworth Clark Jr., D.C.
• Tabitha Cutter
• Whitney Megan Dubois, PHARMD
• Gracie Ann Ducker
• Nicole Dutton
• Carl Peter Eisenbiegler, PHARM.D.

• Chiropractor in Lyndonville, VT
• Providers in Lyndonville, VT by specialty
• Chiropractor in Vermont

• 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.

Verify at the official NPI Registry.