Provider Demographics
NPI:1861770836
Name:STOCK, CORY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:WAYNE
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 1:5862 FIRETHORNE DR APT O
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6781
Mailing Address - Country:US
Mailing Address - Phone:316-617-7435
Mailing Address - Fax:419-482-7745
Practice Address - Street 1:1361 CONANT ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1609
Practice Address - Country:US
Practice Address - Phone:419-740-5833
Practice Address - Fax:419-482-7745
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor