Provider Demographics
NPI:1104937028
Name:STAKES, DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:STAKES
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 1:9609 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA483111N00000X
OK2312111N00000X
TX2943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6001179OtherBCBS
TX350005894OtherRAILROAD MEDICARE
TXT16062Medicare UPIN