=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932382462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STOVER FAMILY CHIROPRACTIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 10/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1710 W 3RD ST SUITE 102
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-5159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-9944
-----------------------------------------------------
Fax | 580-225-9943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 48
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73648-0048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-9944
-----------------------------------------------------
Fax | 580-225-9943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. SHILOAH ADAM STOVER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 580-225-9944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3755
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------