Provider Demographics
NPI:1134419237
Name:STOCKTON, SUSAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 NW OO HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7626
Mailing Address - Country:US
Mailing Address - Phone:660-747-6280
Mailing Address - Fax:
Practice Address - Street 1:388 NW OO HWY
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-7626
Practice Address - Country:US
Practice Address - Phone:660-747-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor