Provider Demographics
NPI:1811166051
Name:STACHELEK, DENNIS SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SCOTT
Last Name:STACHELEK
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 1:5069 WATERWAY DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1259
Mailing Address - Country:US
Mailing Address - Phone:703-580-8388
Mailing Address - Fax:703-580-8628
Practice Address - Street 1:5069 WATERWAY DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1259
Practice Address - Country:US
Practice Address - Phone:703-580-8388
Practice Address - Fax:703-580-8628
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000108B43Medicare PIN