Provider Demographics
NPI:1336150705
Name:STOCKWELL, TODD (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
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 1:75 REMITTANCE DR DEPT 6008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6008
Mailing Address - Country:US
Mailing Address - Phone:562-282-1419
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:2220 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2521
Practice Address - Country:US
Practice Address - Phone:562-597-4181
Practice Address - Fax:562-597-7083
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17831111N00000X
CA17831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA350053321OtherRAILROAD MEDICARE
CADC0178310Medicaid
CA00DC178310OtherBLUE SHIELD
CAU26338Medicare UPIN
CA00DC178310OtherBLUE SHIELD