Individual provider Active NPI

Jacob Edward Stock, D.C.

  • Chiropractor
  • Punta Gorda, FL
National Provider Identifier
1871747212
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH11900 Issued in FL
Practice address
2310 Tamiami TRL
Suite 2121
Punta Gorda, FL 33950-5932
Phone
(941) 205-2225
Fax
(941) 205-3000
NPI assigned
Nov 12, 2008
Last updated
Apr 25, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011191 IL
Chiropractor 111N00000X CH11900 FL Primary

Addresses

Primary practice location

2310 Tamiami TRL
Suite 2121
Punta Gorda, FL 33950-5932

Mailing address

2310 Tamiami TRL
Suite 2121
Punta Gorda, FL 33950-5932
Phone (941) 205-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170801000815 FL Practitioner - Chiropractic 8820154974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2310 Tamiami TRL
Unit 2121
Punta Gorda, FL 33950-5934
Phone (941) 205-2225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH11900FLMDChiropractor
038011191ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pure Health Physical Medicine, LLC Chiropractor CurrentSince Mar 11, 2013 Accepting new patients
Stock Chiropractic Wellness Center, P.a. Chiropractor CurrentSince May 22, 2017 Accepting new patients

Locations

2310 Tamiami Trl
Unit 2121
Punta Gorda, FL 33950
Phone (941) 205-2225

2116 W Galena Blvd
Ste 112
Aurora, IL 60506
Phone (630) 897-1895

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1871747212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 TAMIAMI TRL",
            "address_2": "SUITE 2121",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339505932",
            "telephone_number": "941-205-2225",
            "fax_number": "941-205-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 TAMIAMI TRL",
            "address_2": "SUITE 2121",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339505932",
            "telephone_number": "941-205-2225",
            "fax_number": "941-205-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCK",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-12",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011191",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.