Provider Demographics
NPI:1962581777
Name:STOUT CHIROPRACTIC CLINIC, P. A.
Entity type:Organization
Organization Name:STOUT CHIROPRACTIC CLINIC, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-786-8834
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty