Provider Demographics
NPI:1689360059
Name:STOM CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:STOM CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:STOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-956-8333
Mailing Address - Street 1:2125 YOUNGS CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6319
Mailing Address - Country:US
Mailing Address - Phone:925-956-8333
Mailing Address - Fax:925-947-1122
Practice Address - Street 1:7001 SUNNE LN # 112
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3622
Practice Address - Country:US
Practice Address - Phone:925-956-8333
Practice Address - Fax:925-947-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty