Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH3206 | FL |
NPI | 1043283328 |
---|---|
Provider Name | Dr. James Michael Stock |
First Address | Hollywood, FL 33020-6605 |
Second Address | Hollywood, FL 33020-6605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
381374600 | (05) | FL |
T55815 | (02) | FL |