Provider Demographics
NPI:1063747376
Name:STOCKWELL, JOSHUA H (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:H
Last Name:STOCKWELL
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 1:1640 E 11245 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092
Mailing Address - Country:US
Mailing Address - Phone:801-739-3370
Mailing Address - Fax:734-661-4828
Practice Address - Street 1:11585 S STATE ST.
Practice Address - Street 2:SUITE #102
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-701-2111
Practice Address - Fax:385-342-3811
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2022-07-14
Deactivation Date:2020-04-08
Deactivation Code:
Reactivation Date:2020-04-10
Provider Licenses
StateLicense IDTaxonomies
MI2301009858111N00000X
UT5207124-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor