Provider Demographics
NPI:1528712239
Name:STAHLEY, MASON MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:MICHAEL
Last Name:STAHLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 20TH ST E APT F206
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-1015
Mailing Address - Country:US
Mailing Address - Phone:916-719-5616
Mailing Address - Fax:
Practice Address - Street 1:13003 SE KENT KANGLEY RD STE 110
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7919
Practice Address - Country:US
Practice Address - Phone:253-638-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61257998111N00000X
WACH.61257998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor