Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-24927 | CA |
NPI | 1003841743 |
---|---|
Provider Name | Richard Stockmaster |
First Address | Newport Beach, CA 92660-2213 |
Second Address | Newport Beach, CA 92660-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC-24927 | CA LICENSE (01) | CA |