MEDICARE: BACK PAIN INSTITUTE OF PORT CHARLOTTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8648	FL

General Provider Information

NPI Number	:	1164626149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK PAIN INSTITUTE OF PORT CHARLOTTE LLC

Provider Business Mailing Address
First Line	:	2496 CARING WAY
Second Line	:	SUITE B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5336
Country	:	US
Telephone Number	:	941-235-3535
Fax Number	:	941-235-3550

Provider Business Practice Location Address
First Line	:	2496 CARING WAY
Second Line	:	SUITE B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5336
Country	:	US
Telephone Number	:	941-235-3535
Fax Number	:	941-235-3550

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DR. STEPHEN DOUGLAS STOKES
Credential	:	D.C.
Telephone Number	:	941-235-3535

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	09/11/2007

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