Provider Demographics
NPI:1871662593
Name:STOCKTON, ALISSA MARJORIE (LAC, DOM)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:MARJORIE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:MRS
Other - First Name:ALISSA
Other - Middle Name:MARJORIE
Other - Last Name:POLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1059 N. COLLEGE AVE.
Mailing Address - Street 2:PO BOX 1119
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552
Mailing Address - Country:US
Mailing Address - Phone:928-965-9545
Mailing Address - Fax:
Practice Address - Street 1:1059 N. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552
Practice Address - Country:US
Practice Address - Phone:928-965-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0373171100000X
AZAZ0373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
015873OtherNCCAOM