Provider Demographics
NPI:1972789816
Name:STOUDER CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:STOUDER CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-335-8534
Mailing Address - Street 1:1100 WAYNE ST
Mailing Address - Street 2:SUITE 1460
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3048
Mailing Address - Country:US
Mailing Address - Phone:937-335-8534
Mailing Address - Fax:937-335-4546
Practice Address - Street 1:1100 WAYNE ST
Practice Address - Street 2:SUITE 1460
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3048
Practice Address - Country:US
Practice Address - Phone:937-335-8534
Practice Address - Fax:937-335-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU95643Medicare UPIN
OH9345251Medicare PIN