Provider Demographics
NPI:1750504304
Name:STOUT, MELISSA A (DC, FIAMA)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:STOUT
Suffix:
Gender:F
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 S BERKLEY RD
Mailing Address - Street 2:SUITE #1-B
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-8025
Mailing Address - Country:US
Mailing Address - Phone:765-455-2014
Mailing Address - Fax:765-455-6099
Practice Address - Street 1:2705 S BERKLEY RD
Practice Address - Street 2:SUITE #1-B
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-8025
Practice Address - Country:US
Practice Address - Phone:765-455-2014
Practice Address - Fax:765-455-6099
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002075A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000297700OtherANTHEM #
INP00121563OtherMEDICARE RAIL ROAD
INP00121563OtherMEDICARE RAIL ROAD
INU96432Medicare UPIN