Provider Demographics
NPI:1063858710
Name:BLAIR-STURTEVANT, DEMORIE RAEANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:DEMORIE
Middle Name:RAEANNA
Last Name:BLAIR-STURTEVANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DEMORIE
Other - Middle Name:RAEANNA
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61051-0132
Mailing Address - Country:US
Mailing Address - Phone:815-855-3061
Mailing Address - Fax:815-855-3062
Practice Address - Street 1:444 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61051-9506
Practice Address - Country:US
Practice Address - Phone:815-855-3061
Practice Address - Fax:815-855-3062
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor