Provider Demographics
NPI:1760487136
Name:STOCK, ANN M (DC)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:STOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:219 SOUTH ILLINOIS STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2161
Mailing Address - Country:US
Mailing Address - Phone:618-236-0028
Mailing Address - Fax:618-222-1933
Practice Address - Street 1:219 SOUTH ILLINOIS STREET
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2161
Practice Address - Country:US
Practice Address - Phone:618-236-0028
Practice Address - Fax:618-222-1933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL119174OtherHEALTHLINK
IL4410001OtherUNITED HEALTH CARE
IL8282043OtherBLUE CROSS BLUE SHIELD
ILP00065796OtherRAILROAD MEDICARE
ILP00065796OtherRAILROAD MEDICARE
IL119174OtherHEALTHLINK