Provider Demographics
NPI:1649350497
Name:STOUTLAND, CAROL J (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:STOUTLAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 COBURG RD # 4-1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4982
Mailing Address - Country:US
Mailing Address - Phone:541-484-5433
Mailing Address - Fax:
Practice Address - Street 1:1755 COBURG RD # 4-1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4982
Practice Address - Country:US
Practice Address - Phone:541-484-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131518Medicare ID - Type Unspecified