Provider Demographics
NPI:1134280308
Name:STOCKWELL, GAYLE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ANN
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 N WILMOT RD
Mailing Address - Street 2:SUITE #101A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-885-1866
Mailing Address - Fax:520-885-8476
Practice Address - Street 1:1611 N WILMOT RD
Practice Address - Street 2:SUITE #101A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-885-1866
Practice Address - Fax:520-885-8476
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5018111N00000X
CA21524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0244710OtherBC BS
AZ0244710OtherBC BS