Healthcare Provider Details

I. General information

NPI: 1922015668
Provider Name (Legal Business Name): STEPHANIE A CLUVER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E SIDE SQ
CLINTON IL
61727-1655
US

IV. Provider business mailing address

203 E SIDE SQ
CLINTON IL
61727-1655
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-6555
  • Fax: 217-935-4969
Mailing address:
  • Phone: 217-935-6555
  • Fax: 217-935-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: