Healthcare Provider Details

I. General information

NPI: 1316597586
Provider Name (Legal Business Name): KATHERINE ROSE STOCK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 E OVERLAND RD
MERIDIAN ID
83642-6687
US

IV. Provider business mailing address

4600 KIETZKE LN STE N258
RENO NV
89502-5000
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-3113
  • Fax: 208-376-4114
Mailing address:
  • Phone: 307-461-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01786
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15117
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIACN-2351
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-2326
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: