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General NPI Number Information
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NPI Number | 1376941088
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Entity Type | Organization
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Legal Business Name | STACEY A CLINE DC S.C.
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 55 S MAIN ST SUITE 294
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City | NAPERVILLE
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State | IL
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Zip | 60540-5372
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Country | US
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Telephone | 630-428-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 0S501 PRESTON CIR
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City | GENEVA
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State | IL
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Zip | 60134-6147
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Country | US
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Telephone | 563-503-1037
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STACEY A CLINE
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Credential |
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Telephone | 563-503-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038011454
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License Number State | IL
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