Provider Demographics
NPI:1720295355
Name:STOCKWELL, EVERETT JACKSON (DC)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:JACKSON
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 S JORDAN GTWY STE 220
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3931
Mailing Address - Country:US
Mailing Address - Phone:801-523-1890
Mailing Address - Fax:801-523-1495
Practice Address - Street 1:10714 S JORDAN GTWY STE 220
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3931
Practice Address - Country:US
Practice Address - Phone:801-523-1890
Practice Address - Fax:801-523-1495
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285482-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor