MEDICARE: DR. ANN M STOCK D.C.

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	038005768	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00065796	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119174	OTHER	IL	HEALTHLINK
2	4410001	OTHER	IL	UNITED HEALTH CARE
3	8282043	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760487136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN M STOCK D.C.

Provider Business Mailing Address
First Line	:	219 SOUTH ILLINOIS STREET
Second Line	:	SUITE D
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-2161
Country	:	US
Telephone Number	:	618-236-0028
Fax Number	:	618-222-1933

Provider Business Practice Location Address
First Line	:	219 SOUTH ILLINOIS STREET
Second Line	:	SUITE D
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-2161
Country	:	US
Telephone Number	:	618-236-0028
Fax Number	:	618-222-1933

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	10/07/2008

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Directions to “ DR. ANN M STOCK D.C.” Practice Location

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