Provider Demographics
NPI:1427851013
Name:STOUT, ALLYSA NOEL (DC)
Entity type:Individual
Prefix:
First Name:ALLYSA
Middle Name:NOEL
Last Name:STOUT
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S MANUS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1380
Mailing Address - Country:US
Mailing Address - Phone:850-758-5788
Mailing Address - Fax:
Practice Address - Street 1:1808 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5439
Practice Address - Country:US
Practice Address - Phone:469-781-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor