Provider Demographics
NPI:1245463066
Name:STOCKMAN, ANDREW ZACHARIAH (L AC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ZACHARIAH
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:668 DULUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2227
Practice Address - Country:US
Practice Address - Phone:651-209-8383
Practice Address - Fax:612-728-0377
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1460171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist