Provider Demographics
NPI:1275912545
Name:RAFOOL, LINDSEY LEA (DC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:LEA
Last Name:RAFOOL
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 1:719 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5941
Mailing Address - Country:US
Mailing Address - Phone:309-691-9355
Mailing Address - Fax:309-691-9357
Practice Address - Street 1:719 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5941
Practice Address - Country:US
Practice Address - Phone:309-691-9355
Practice Address - Fax:309-691-9357
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor