Healthcare Provider Details

I. General information

NPI: 1760487136
Provider Name (Legal Business Name): ANN M STOCK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 SOUTH ILLINOIS STREET SUITE D
BELLEVILLE IL
62220-2161
US

IV. Provider business mailing address

219 SOUTH ILLINOIS STREET SUITE D
BELLEVILLE IL
62220-2161
US

V. Phone/Fax

Practice location:
  • Phone: 618-236-0028
  • Fax: 618-222-1933
Mailing address:
  • Phone: 618-236-0028
  • Fax: 618-222-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038005768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: