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General NPI Number Information
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NPI Number | 1962581777
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Entity Type | Organization
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Legal Business Name | STOUT CHIROPRACTIC CLINIC, P. A.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1107 E 13TH ST SUITE A&B
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City | GROVE
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State | OK
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Zip | 74344-7955
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Country | US
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Telephone | 918-786-8834
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Fax | 918-786-6520
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Provider Business Mailing Address
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Address Line | PO BOX 6987
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City | GROVE
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State | OK
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Zip | 74344-6987
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Country | US
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Telephone | 918-786-8834
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Fax | 918-786-6520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY EUGENE STOUT
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Credential | D.C.
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Telephone | 918-786-8834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3386
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License Number State | OK
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