Healthcare Provider Details

I. General information

NPI: 1972149557
Provider Name (Legal Business Name): STOCK CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 S DEFIO PL
MERIDIAN ID
83642-5764
US

IV. Provider business mailing address

18124 WEDGE PKWY # 992
RENO NV
89511-8134
US

V. Phone/Fax

Practice location:
  • Phone: 307-461-9844
  • Fax:
Mailing address:
  • Phone: 307-461-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE STOCK
Title or Position: DOCTOR / OWNER
Credential: DC
Phone: 307-461-9844