MEDICARE: DR. JACOB EDWARD 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	038011191	IL
2	111N00000X	Chiropractor	CH11900	FL

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

General Provider Information

NPI Number	:	1871747212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB EDWARD STOCK D.C.

Provider Business Mailing Address
First Line	:	2310 TAMIAMI TRL
Second Line	:	SUITE 2121
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5932
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

Provider Business Practice Location Address
First Line	:	2310 TAMIAMI TRL
Second Line	:	SUITE 2121
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-5932
Country	:	US
Telephone Number	:	941-205-2225
Fax Number	:	941-205-3000

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	04/25/2017

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