Healthcare Provider Details

I. General information

NPI: 1073505368
Provider Name (Legal Business Name): EDWARD J STOCKLI D C PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

12 CAVALIN DR
MONTGOMERY NY
12549-2235
US

IV. Provider business mailing address

12 CAVALIN DR
MONTGOMERY NY
12549-2235
US

V. Phone/Fax

Practice location:
  • Phone: 845-457-4447
  • Fax: 845-457-1785
Mailing address:
  • Phone: 845-457-4447
  • Fax: 845-457-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007746-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: