Provider Demographics
NPI:1174213359
Name:STOUDER, LEO B JR (DC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:B
Last Name:STOUDER
Suffix:JR
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 1:3475 SHERIDAN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3659
Mailing Address - Country:US
Mailing Address - Phone:954-665-6443
Mailing Address - Fax:
Practice Address - Street 1:3475 SHERIDAN ST STE 207
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3659
Practice Address - Country:US
Practice Address - Phone:954-665-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4197111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation