Provider Demographics
NPI:1972672202
Name:STOUT, MADELAINE MAE (BA, DC)
Entity Type:Individual
Prefix:DR
First Name:MADELAINE
Middle Name:MAE
Last Name:STOUT
Suffix:
Gender:F
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ENGLISH DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1627
Mailing Address - Country:US
Mailing Address - Phone:307-235-4956
Mailing Address - Fax:307-235-1654
Practice Address - Street 1:735 ENGLISH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1627
Practice Address - Country:US
Practice Address - Phone:307-235-4956
Practice Address - Fax:307-235-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYT8035Medicare UPIN
WY302449Medicare ID - Type Unspecified