Provider Demographics
NPI:1164727921
Name:STOKES, JUSTIN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RYAN
Last Name:STOKES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6906 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1127
Mailing Address - Country:US
Mailing Address - Phone:719-358-7422
Mailing Address - Fax:719-375-5934
Practice Address - Street 1:6906 N ACADEMY BLVD
Practice Address - Street 2:SUITE 1F
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1127
Practice Address - Country:US
Practice Address - Phone:719-358-7422
Practice Address - Fax:719-375-5934
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4158111N00000X
IA007370111N00000X
CO0006833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164727921Medicare NSC