Provider Demographics
NPI:1043382534
Name:STOKES, GREGORY P (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:STOKES
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-0181
Mailing Address - Country:US
Mailing Address - Phone:610-749-0611
Mailing Address - Fax:610-749-0911
Practice Address - Street 1:101 DELAWARE RD
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077-7005
Practice Address - Country:US
Practice Address - Phone:610-749-0611
Practice Address - Fax:610-749-0911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006302L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0833961000OtherPERSONAL CHOICE
PA5214126OtherAENTA ID#
PA808232OtherBLUE SHIELD ID#
PA23-2827854OtherTAX ID#
PA369667000OtherINDEPENDENCE BLUE
PA1032053OtherASHN ID#
PAP1121505OtherOXFORD ID#
PA5214126OtherAENTA ID#
PAU60407Medicare UPIN