Provider Demographics
NPI:1881983047
Name:STADING, KENNETH MAXWELL (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MAXWELL
Last Name:STADING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8342
Mailing Address - Country:US
Mailing Address - Phone:719-648-5923
Mailing Address - Fax:888-502-7161
Practice Address - Street 1:6535 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8342
Practice Address - Country:US
Practice Address - Phone:719-648-5923
Practice Address - Fax:888-502-7161
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4256111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner