Provider Demographics
NPI:1528257227
Name:STOKLOSA, LESLIE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARIE
Last Name:STOKLOSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3572
Mailing Address - Country:US
Mailing Address - Phone:716-200-2561
Mailing Address - Fax:
Practice Address - Street 1:2994 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-8222
Practice Address - Country:US
Practice Address - Phone:336-783-9400
Practice Address - Fax:336-783-9406
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor