Provider Demographics
NPI:1083718555
Name:STAKER, MICHAEL TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:STAKER
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 1:3550 NW CARY PARKWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-7410
Mailing Address - Country:US
Mailing Address - Phone:919-460-1515
Mailing Address - Fax:919-460-1979
Practice Address - Street 1:3550 NW CARY PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-7410
Practice Address - Country:US
Practice Address - Phone:919-460-1515
Practice Address - Fax:919-460-1979
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01211OtherBCBS
NC8908815Medicaid
NC01211OtherBCBS
NCU62868Medicare UPIN