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Individual

DR. BENJAMIN R. STOUT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C., F.I.A.M.A.

Contact information

Practice address
2705 S BERKLEY RD, SUITE #1-B, KOKOMO, IN 46902-8025
(765) 455-2014
(765) 455-6099
Mailing address
2705 S BERKLEY RD, SUITE #1-B, KOKOMO, IN 46902-8025
(765) 455-2014
(765) 455-6099

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002054A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000299777
ANTHEM #
IN
01
P00129466
MEDICARE RAIL ROAD
IN
Enumeration date
04/11/2007
Last updated
07/08/2007
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