Provider Demographics
NPI:1073505368
Name:STOCKLI, EDWARD J (D C PC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:STOCKLI
Suffix:
Gender:M
Credentials:D C PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CAVALIN DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2235
Mailing Address - Country:US
Mailing Address - Phone:845-457-4447
Mailing Address - Fax:845-457-1785
Practice Address - Street 1:12 CAVALIN DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2235
Practice Address - Country:US
Practice Address - Phone:845-457-4447
Practice Address - Fax:845-457-1785
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-03-27
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NYX007746-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX00281Medicare ID - Type Unspecified
NYU54370Medicare UPIN