Provider Demographics
NPI:1508036823
Name:ISDALE CHIROPRACTIC CLINIC OF COPPERAS COVE
Entity Type:Organization
Organization Name:ISDALE CHIROPRACTIC CLINIC OF COPPERAS COVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-547-6654
Mailing Address - Street 1:211 LIBERTY BELL LN STE 111
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2588
Mailing Address - Country:US
Mailing Address - Phone:254-547-6654
Mailing Address - Fax:
Practice Address - Street 1:211 LIBERTY BELL LN STE 111
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2588
Practice Address - Country:US
Practice Address - Phone:254-547-6654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty