Provider Demographics
NPI:1801182795
Name:EDWARD J. STOCKLI, D.C., P.C.
Entity Type:Organization
Organization Name:EDWARD J. STOCKLI, D.C., P.C.
Other - Org Name:CORNERSTONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-457-4447
Mailing Address - Street 1:12 CAVALIN DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2235
Mailing Address - Country:US
Mailing Address - Phone:845-457-4447
Mailing Address - Fax:845-457-1785
Practice Address - Street 1:12 CAVALIN DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2235
Practice Address - Country:US
Practice Address - Phone:845-457-4447
Practice Address - Fax:845-457-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007746-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty