Provider Demographics
NPI:1265636278
Name:RAYMOND, STACIE MARYANN (DC)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:MARYANN
Last Name:RAYMOND
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 1:1909 W NEW MONEE RD
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-8036
Mailing Address - Country:US
Mailing Address - Phone:708-672-9559
Mailing Address - Fax:
Practice Address - Street 1:1230 N CONVENT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1474
Practice Address - Country:US
Practice Address - Phone:815-932-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor