Provider Demographics
NPI:1316597586
Name:STOCK, KATHERINE ROSE (DC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:STOCK
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 1:4600 KIETZKE LN
Mailing Address - Street 2:STE N258
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5000
Mailing Address - Country:US
Mailing Address - Phone:307-461-9844
Mailing Address - Fax:
Practice Address - Street 1:1899 E OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6687
Practice Address - Country:US
Practice Address - Phone:208-376-3113
Practice Address - Fax:208-376-4114
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01786111N00000X
TX15117111N00000X
IDCHIACN-2351111NN1001X
IDCHIA-2326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition