Healthcare Provider Details

I. General information

NPI: 1952247132
Provider Name (Legal Business Name): BACK PRO CHIRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
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:
Mailing address:
  • Phone: 224-297-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA STOUT
Title or Position: OWNER
Credential: DC
Phone: 224-297-7535