Provider Demographics
NPI:1447562509
Name:STOKE CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:STOKE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CRONK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-344-6738
Mailing Address - Street 1:217 ALBEMARLE AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4716
Mailing Address - Country:US
Mailing Address - Phone:540-344-6738
Mailing Address - Fax:540-344-8047
Practice Address - Street 1:217 ALBEMARLE AVENUE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4716
Practice Address - Country:US
Practice Address - Phone:540-344-6738
Practice Address - Fax:540-344-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000580Medicare PIN