Provider Demographics
NPI:1407002181
Name:WHITE SULPHUR SPRINGS CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:WHITE SULPHUR SPRINGS CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STOKLOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-786-6565
Mailing Address - Street 1:2994 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-8222
Mailing Address - Country:US
Mailing Address - Phone:336-786-6565
Mailing Address - Fax:336-786-5110
Practice Address - Street 1:2994 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-8222
Practice Address - Country:US
Practice Address - Phone:336-786-6565
Practice Address - Fax:336-786-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty