MEDICARE: STOCK CHIROPRACTIC WELLNESS CENTER, P.A.

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	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548570799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOCK CHIROPRACTIC WELLNESS CENTER, P.A.

Provider Business Mailing Address
First Line	:	2310 TAMIAMI TRL UNIT 2121
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5934
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

Provider Business Practice Location Address
First Line	:	2310 TAMIAMI TRL UNIT 2121
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5934
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB EDWARD STOCK
Credential	:	DC
Telephone Number	:	941-205-2225

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	05/29/2020

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Directions to “STOCK CHIROPRACTIC WELLNESS CENTER, P.A. ” Practice Location

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