NPIMap

Individual provider Active NPI

Kenneth Ray Stillwell, D.C.

  • Chiropractor
  • Tacoma, WA
National Provider Identifier
1790960813
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00001328 Issued in WA
Practice address
4537 Yakima Ave
Tacoma, WA 98418-4929
Phone
(253) 475-3334
Fax
(253) 475-0875
NPI assigned
Jan 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00001328 WA Primary

Addresses

Primary practice location

4537 Yakima Ave
Tacoma, WA 98418-4929

Mailing address

4537 Yakima Ave
Tacoma, WA 98418-4929
Phone (253) 475-3334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH00001328WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Still Well Chiropractic Clinic Inc Chiropractor PastSince Dec 1, 2005 Accepting new patients
Brent Finnigan LMP Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200355200000",
    "number": "1790960813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4537 YAKIMA AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984184929",
            "telephone_number": "253-475-3334",
            "fax_number": "253-475-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4537 YAKIMA AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984184929",
            "telephone_number": "253-475-3334",
            "fax_number": "253-475-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLWELL",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00001328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.