Provider Demographics
NPI:1184739864
Name:STALLINGS, THERON NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:THERON
Middle Name:NEIL
Last Name:STALLINGS
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 1:2200 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1419
Mailing Address - Country:US
Mailing Address - Phone:970-484-0686
Mailing Address - Fax:970-484-0689
Practice Address - Street 1:2200 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1419
Practice Address - Country:US
Practice Address - Phone:970-484-0686
Practice Address - Fax:970-484-0689
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17373Medicare ID - Type Unspecified