Provider Demographics
NPI:1043494511
Name:MATHEW K STOCKSTAD, DC, PA
Entity Type:Organization
Organization Name:MATHEW K STOCKSTAD, DC, PA
Other - Org Name:CHRIOPRACTIC FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:STOCKSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-299-4555
Mailing Address - Street 1:16 WINTERWIND DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-9606
Mailing Address - Country:US
Mailing Address - Phone:828-299-4555
Mailing Address - Fax:828-299-4121
Practice Address - Street 1:16 WINTERWIND DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9606
Practice Address - Country:US
Practice Address - Phone:828-299-4555
Practice Address - Fax:828-299-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty