Provider Demographics
NPI:1417246836
Name:STOUT, ADAM L (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:L
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 1:6718 N NEBRASKA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604
Mailing Address - Country:US
Mailing Address - Phone:813-822-6804
Mailing Address - Fax:813-522-6722
Practice Address - Street 1:6718 N NEBRASKA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604
Practice Address - Country:US
Practice Address - Phone:813-822-6804
Practice Address - Fax:813-522-6722
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008402800Medicaid