Healthcare Provider Details

I. General information

NPI: 1174378525
Provider Name (Legal Business Name): CHACON BNK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 PLAZA DR STE 110
ROCKLIN CA
95765-4427
US

IV. Provider business mailing address

2203 PLAZA DR STE 110
ROCKLIN CA
95765-4427
US

V. Phone/Fax

Practice location:
  • Phone: 916-938-2531
  • Fax:
Mailing address:
  • Phone: 916-938-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: STACY NORTHEY
Title or Position: BILLING AND CREDENTIALING MANAGER
Credential:
Phone: 928-531-9171