Provider Demographics
NPI:1508962481
Name:STOCKTON, LOREN CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:CRAIG
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PILLSBURY AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3835
Mailing Address - Country:US
Mailing Address - Phone:952-890-9055
Mailing Address - Fax:952-890-7515
Practice Address - Street 1:12400 PILLSBURY AVE S
Practice Address - Street 2:1
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3835
Practice Address - Country:US
Practice Address - Phone:952-890-9055
Practice Address - Fax:952-890-7515
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN28713STOtherBCBS
MN28713STOtherBCBS