1073855086 NPI number — STOUT FAMILY CHIROPRACTIC, P.A.

Table of content: (NPI 1073855086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073855086 NPI number — STOUT FAMILY CHIROPRACTIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOUT FAMILY CHIROPRACTIC, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073855086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 290285
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33687-0285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-701-7272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10956 N 56TH ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
TEMPLE TERRACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33617-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-701-7272
Provider Business Practice Location Address Fax Number:
813-501-1081
Provider Enumeration Date:
03/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STOUT
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-787-6764

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH10219 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH9983 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 015449400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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