Provider Demographics
NPI:1912943036
Name:STOCKTON, MICHELE M (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:M
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 1:1113 W LAKE ST
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9304
Mailing Address - Country:US
Mailing Address - Phone:989-362-9910
Mailing Address - Fax:989-362-8198
Practice Address - Street 1:1113 W LAKE ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48764
Practice Address - Country:US
Practice Address - Phone:989-362-9910
Practice Address - Fax:989-362-8198
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C550070OtherBLUE CROSS
MI0M79090Medicare ID - Type Unspecified