Provider Demographics
NPI:1093892309
Name:STOCKDALE CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:STOCKDALE CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:TRYGGESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-587-0700
Mailing Address - Street 1:7916 HILLIARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6782
Mailing Address - Country:US
Mailing Address - Phone:661-747-1210
Mailing Address - Fax:702-242-0257
Practice Address - Street 1:4550 COFFEE RD
Practice Address - Street 2:STE. H
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5023
Practice Address - Country:US
Practice Address - Phone:661-587-0700
Practice Address - Fax:661-587-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26083ZMedicare ID - Type Unspecified