Provider Demographics
NPI:1265501704
Name:STONITSCH, SUSAN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:STONITSCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-2766
Mailing Address - Country:US
Mailing Address - Phone:815-626-1887
Mailing Address - Fax:815-626-9602
Practice Address - Street 1:808 W ROCK FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-2766
Practice Address - Country:US
Practice Address - Phone:815-626-1887
Practice Address - Fax:815-626-9602
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9827470OtherBCBS
ILU79287Medicare UPIN
IL203008Medicare ID - Type Unspecified