Provider Demographics
NPI:1003841743
Name:STOCKMASTER, RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STOCKMASTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BIRCH ST
Mailing Address - Street 2:STE. 107
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2213
Mailing Address - Country:US
Mailing Address - Phone:949-851-8700
Mailing Address - Fax:
Practice Address - Street 1:4020 BIRCH ST
Practice Address - Street 2:STE. 107
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2213
Practice Address - Country:US
Practice Address - Phone:949-851-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-24927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-24927OtherCA LICENSE