Provider Demographics
NPI:1164722831
Name:STONER, BRENDA CLAY
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CLAY
Last Name:STONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 VALDOSTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2863
Mailing Address - Country:US
Mailing Address - Phone:502-491-2620
Mailing Address - Fax:
Practice Address - Street 1:2600 W BROADWAY
Practice Address - Street 2:SUITE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1366
Practice Address - Country:US
Practice Address - Phone:502-742-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000296111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation