Jacki L Strader, LMP

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00009325 Issued in WA

Practice address

109 Rainier Avenue South
Suite C
Eatonville, WA 98328-0546

Phone

(360) 832-6200

NPI assigned

May 30, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mashell Chiropractic Clinic, Inc.

  dba Dale E. Clark, D.C., P.S.

  • Health Service Clinic/Center
  • Eatonville, WA
  • NPI 1841567252
  NPD (past)

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780885392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983540911",
            "telephone_number": "253-530-7819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 RAINIER AVENUE SOUTH",
            "address_2": "SUITE C",
            "city": "EATONVILLE",
            "state": "WA",
            "postal_code": "983280546",
            "telephone_number": "360-832-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STRADER",
        "first_name": "JACKI",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00009325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "109448",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PROVIDER",
            "identifier": "5586ST",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Sanderson
• Katherine E Schertz, LMP, NTP
• Shannon Smith
• Whitney Lin Smith
• South Pierce Fire and Rescue District No 17
• Penny Leah Tanner, PHD, ARNP, PMHNP-BC
• Melissa Dawn Taylor
• Dawn Tippett
• Town of Eatonville
• Jennifer Marie Travis, RNFA

• Specialist in Eatonville, WA
• Providers in Eatonville, WA by specialty
• Specialist in Washington

• 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.

Verify at the official NPI Registry.