MEDICARE: DR. TRACEY DENISE STILES 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	111NI0900X	Internist Chiropractor	038006300	IL
2	111N00000X	Chiropractor	038006300	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1605840	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1912076316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY DENISE STILES D.C.

Provider Business Mailing Address
First Line	:	658 N DEARBORN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3816
Country	:	US
Telephone Number	:	312-642-1138
Fax Number	:	312-642-1349

Provider Business Practice Location Address
First Line	:	658 N DEARBORN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3816
Country	:	US
Telephone Number	:	312-642-1138
Fax Number	:	312-642-1349

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	06/15/2022

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