Provider Demographics
NPI:1396759486
Name:STOCKTON, JOHN BURTON (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BURTON
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 LIBERTY BELL LN STE 111
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2588
Mailing Address - Country:US
Mailing Address - Phone:254-547-6654
Mailing Address - Fax:254-547-6652
Practice Address - Street 1:211 LIBERTY BELL LN STE 111
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2588
Practice Address - Country:US
Practice Address - Phone:254-547-6654
Practice Address - Fax:254-547-6652
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00900KMedicare PIN
TX8B2343Medicare PIN