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General NPI Number Information
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NPI Number | 1326221961
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Entity Type | Organization
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Legal Business Name | DR. STEPHANIE LACEY, LLC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 148 N WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-4512
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Country | US
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Telephone | 630-961-2848
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Fax |
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Provider Business Mailing Address
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Address Line | 148 N WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-4512
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Country | US
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Telephone | 630-961-2848
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ANTHONY PENDOLINO
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Credential | D.C.
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Telephone | 630-961-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-007426
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License Number State | IL
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