Provider Demographics
NPI:1194734343
Name:STOUT, LARRY E (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:STOUT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6987
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6987
Mailing Address - Country:US
Mailing Address - Phone:918-786-8834
Mailing Address - Fax:918-786-6520
Practice Address - Street 1:1107 E 13TH ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7955
Practice Address - Country:US
Practice Address - Phone:918-786-8834
Practice Address - Fax:918-786-6520
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT77100Medicare UPIN