Provider Demographics
NPI:1134395452
Name:STAKES CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:STAKES CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-892-2160
Mailing Address - Street 1:9609 STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-2411
Mailing Address - Country:US
Mailing Address - Phone:512-892-2160
Mailing Address - Fax:512-892-7309
Practice Address - Street 1:7413 OLD BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8234
Practice Address - Country:US
Practice Address - Phone:512-892-2160
Practice Address - Fax:512-892-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T16062Medicare UPIN
601179Medicare PIN