Healthcare Provider Details

I. General information

NPI: 1770791352
Provider Name (Legal Business Name): STOUT CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 S BERKLEY RD SUITE #1-B
KOKOMO IN
46902-8025
US

IV. Provider business mailing address

2705 S BERKLEY RD SUITE #1-B
KOKOMO IN
46902-8025
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-2014
  • Fax: 765-455-6099
Mailing address:
  • Phone: 765-455-2014
  • Fax: 765-455-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number51000387A
License Number StateIN

VIII. Authorized Official

Name: DR. BENJAMIN R. STOUT
Title or Position: OWNER
Credential: D.C.
Phone: 765-455-2014