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General NPI Number Information
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NPI Number | 1093892309
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Entity Type | Organization
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Legal Business Name | STOCKDALE CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4550 COFFEE RD STE. H
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City | BAKERSFIELD
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State | CA
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Zip | 93308-5023
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Country | US
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Telephone | 661-587-0700
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Fax | 661-587-0799
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Provider Business Mailing Address
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Address Line | 7916 HILLIARD AVE
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City | LAS VEGAS
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State | NV
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Zip | 89128-6782
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Country | US
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Telephone | 661-747-1210
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Fax | 702-242-0257
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH ERIC TRYGGESTAD
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Credential | D.C.
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Telephone | 661-587-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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