MEDICARE: DR. NICHOLAS STOCKWELL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	AM2763399-153	MI
2	207X00000X	Orthopaedic Surgery Physician	DR.0066034	CO

General Provider Information

NPI Number	:	1225411242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS STOCKWELL DO

Provider Business Mailing Address
First Line	:	1405 S 8TH AVE
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-4563
Country	:	US
Telephone Number	:	970-522-2264
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 LIMELIGHT AVE STE 100
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-8034
Country	:	US
Telephone Number	:	720-455-3775
Fax Number	:	720-455-3776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	09/06/2022

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