Stacey Anne Dersham, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

001788 Issued in CT

Practice address

657 Pleasant St
Box #5
Fall River, MA 02721-4323

Phone

(508) 677-2554

Fax

(508) 677-2553

NPI assigned

Jun 10, 2008

Last updated

Nov 20, 2013By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384905600000",
    "number": "1871753228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 BRALEY HILL RD",
            "city": "ROCHESTER",
            "state": "MA",
            "postal_code": "027701917",
            "telephone_number": "508-725-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 PLEASANT ST",
            "address_2": "BOX #5",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027214323",
            "telephone_number": "508-677-2554",
            "fax_number": "508-677-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSHAM",
        "first_name": "STACEY",
        "middle_name": "ANNE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2013-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001788",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Fall River, MA
• Providers in Fall River, MA by specialty
• Chiropractor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; 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.