Provider Demographics
NPI:1730142100
Name:STOCKMAN, DANIEL JAMES (ATC/OTC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:ATC/OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7199
Mailing Address - Country:US
Mailing Address - Phone:573-443-2402
Mailing Address - Fax:573-443-0584
Practice Address - Street 1:1 S KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7199
Practice Address - Country:US
Practice Address - Phone:573-443-2402
Practice Address - Fax:573-443-0574
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010258862255A2300X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist