Provider Demographics
NPI:1427687854
Name:STOCKWELL SPINAL CARE, LLC
Entity type:Organization
Organization Name:STOCKWELL SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-739-3370
Mailing Address - Street 1:1640 E 11245 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5137
Mailing Address - Country:US
Mailing Address - Phone:801-739-3370
Mailing Address - Fax:
Practice Address - Street 1:11585 S STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7401
Practice Address - Country:US
Practice Address - Phone:801-701-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty