Provider Demographics
NPI:1962532432
Name:STOCKER, KATHY ANN (DC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:STOCKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W VALLEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1575
Mailing Address - Country:US
Mailing Address - Phone:509-765-8978
Mailing Address - Fax:
Practice Address - Street 1:530 W VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1575
Practice Address - Country:US
Practice Address - Phone:509-765-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0045257OtherLABOR AND INDUSTRIES
WA0045257OtherLABOR AND INDUSTRIES
WAU63326Medicare UPIN