Provider Demographics
NPI:1871747212
Name:STOCK, JACOB EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:EDWARD
Last Name:STOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2310 TAMIAMI TRL
Mailing Address - Street 2:SUITE 2121
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5932
Mailing Address - Country:US
Mailing Address - Phone:941-205-2225
Mailing Address - Fax:941-205-3000
Practice Address - Street 1:2310 TAMIAMI TRL
Practice Address - Street 2:SUITE 2121
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5932
Practice Address - Country:US
Practice Address - Phone:941-205-2225
Practice Address - Fax:941-205-3000
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011191111N00000X
FLCH11900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871747212Medicare UPIN
ILT00736Medicare UPIN