Individual
DR. MANFRED ROSS STOCKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
5027 CREE WAY, BOISE, ID 83709-5344
(208) 362-6530
(208) 362-6530
Mailing address
5027 CREE WAY, BOISE, ID 83709-5344
(208) 362-6530
(208) 362-6530
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-729
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010031901
REGENCE B/C
ID
01
—
C-7291
BLUE CROSS
ID
Enumeration date
01/14/2009
Last updated
01/14/2009
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