MEDICARE: DR. LISA MARIE STOUT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.011022	IL

General Provider Information

NPI Number	:	1326235599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE STOUT D.C.

Provider Business Mailing Address
First Line	:	929 S MAIN ST STE 100
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-3325
Country	:	US
Telephone Number	:	224-297-7535
Fax Number	:	224-297-7535

Provider Business Practice Location Address
First Line	:	57 W VAN BUREN ST
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7213
Country	:	US
Telephone Number	:	630-554-6111
Fax Number	:	630-554-6116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	06/23/2026

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