Provider Demographics
NPI:1972149557
Name:STOCK CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:STOCK CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-461-9844
Mailing Address - Street 1:18124 WEDGE PKWY # 992
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8134
Mailing Address - Country:US
Mailing Address - Phone:307-461-9844
Mailing Address - Fax:
Practice Address - Street 1:2102 S DEFIO PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5764
Practice Address - Country:US
Practice Address - Phone:307-461-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB01786OtherSTATE BOARD LICENSING