Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4256 | CO |
N | 111NI0013X | Independent Medical Examiner | 4256 | CO |
NPI | 1881983047 |
---|---|
Provider Name | Dr. Kenneth Maxwell Stading |
First Address | Colorado Springs, CO 80918-8342 |
Second Address | Colorado Springs, CO 80918-8342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 28/03/2011 |