Provider Demographics
NPI:1073855086
Name:STOUT FAMILY CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:STOUT FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-787-6764
Mailing Address - Street 1:PO BOX 290285
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-0285
Mailing Address - Country:US
Mailing Address - Phone:813-701-7272
Mailing Address - Fax:
Practice Address - Street 1:10956 N 56TH ST
Practice Address - Street 2:201
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3008
Practice Address - Country:US
Practice Address - Phone:813-701-7272
Practice Address - Fax:813-501-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10219111N00000X
FLCH9983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015449400Medicaid