Provider Demographics
NPI:1316926355
Name:STOKER, ROBERT G (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:STOKER
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 1:375 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042
Mailing Address - Country:US
Mailing Address - Phone:860-646-7320
Mailing Address - Fax:860-646-7321
Practice Address - Street 1:375 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042
Practice Address - Country:US
Practice Address - Phone:860-646-7320
Practice Address - Fax:860-646-7321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP1480468OtherOXFORD TRIAD
CT062612OtherCONNECTICARE
CTOV2187OtherPHS MDHP
CT050000612CT01OtherANTHEM BCBS
T22890Medicare UPIN