Healthcare Provider Details

I. General information

NPI: 1164722831
Provider Name (Legal Business Name): BRENDA CLAY STONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W BROADWAY SUITE 208
LOUISVILLE KY
40211-1366
US

IV. Provider business mailing address

3700 VALDOSTA AVE
LOUISVILLE KY
40218-2863
US

V. Phone/Fax

Practice location:
  • Phone: 502-742-2300
  • Fax:
Mailing address:
  • Phone: 502-491-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number000296
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: