Healthcare Provider Details

I. General information

NPI: 1326235599
Provider Name (Legal Business Name): LISA MARIE STOUT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 S MAIN ST STE 100
LOMBARD IL
60148-3325
US

IV. Provider business mailing address

929 S MAIN ST STE 100
LOMBARD IL
60148-3325
US

V. Phone/Fax

Practice location:
  • Phone: 224-297-7535
  • Fax: 224-297-7535
Mailing address:
  • Phone: 224-297-7535
  • Fax: 224-297-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: