1871662593 NPI number — MRS. ALISSA MARJORIE STOCKTON L.AC., D.O.M.

Table of content: MRS. ALISSA MARJORIE STOCKTON L.AC., D.O.M. (NPI 1871662593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871662593 NPI number — MRS. ALISSA MARJORIE STOCKTON L.AC., D.O.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKTON
Provider First Name:
ALISSA
Provider Middle Name:
MARJORIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC., D.O.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLEN
Provider Other First Name:
ALISSA
Provider Other Middle Name:
MARJORIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871662593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1059 N. COLLEGE AVE.
Provider Second Line Business Mailing Address:
PO BOX 1119
Provider Business Mailing Address City Name:
THATCHER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-965-9545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1059 N. COLLEGE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THATCHER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-965-9545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  0373 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: AZ0373 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 015873 . This is a "NCCAOM" identifier . This identifiers is of the category "OTHER".