Healthcare Provider Details

I. General information

NPI: 1366201287
Provider Name (Legal Business Name): MADISON ELAINE STEWART DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 OLD GERMANTOWN RD
GERMANTOWN HILLS IL
61548-8679
US

IV. Provider business mailing address

6135 N KNOLL AIRE DR
PEORIA IL
61614-3420
US

V. Phone/Fax

Practice location:
  • Phone: 309-383-2772
  • Fax: 309-383-2773
Mailing address:
  • Phone: 309-299-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.14142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: