Healthcare Provider Details

I. General information

NPI: 1053249045
Provider Name (Legal Business Name): PRESTON STEVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 CAMDEN CT STE 1E
OAK BROOK IL
60523-4671
US

IV. Provider business mailing address

814 COMMERCE DR STE 300
OAK BROOK IL
60523-8823
US

V. Phone/Fax

Practice location:
  • Phone: 630-791-5263
  • Fax:
Mailing address:
  • Phone: 630-468-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038014423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: