Provider Demographics
NPI:1982472023
Name:STOCK, BRANT TUCKER (DC)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:TUCKER
Last Name:STOCK
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 1:290 N 800 W
Mailing Address - Street 2:
Mailing Address - City:WEST BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84087-1425
Mailing Address - Country:US
Mailing Address - Phone:801-882-4330
Mailing Address - Fax:
Practice Address - Street 1:1681 W 3860 S STE 106
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-6274
Practice Address - Country:US
Practice Address - Phone:801-997-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8715752-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor