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General NPI Number Information
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NPI Number | 1164626149
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Entity Type | Organization
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Legal Business Name | BACK PAIN INSTITUTE OF PORT CHARLOTTE LLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 2496 CARING WAY SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5336
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Country | US
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Telephone | 941-235-3535
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Fax | 941-235-3550
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Provider Business Mailing Address
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Address Line | 2496 CARING WAY SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5336
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Country | US
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Telephone | 941-235-3535
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Fax | 941-235-3550
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. STEPHEN DOUGLAS STOKES
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Credential | D.C.
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Telephone | 941-235-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8648
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License Number State | FL
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