Provider Demographics
NPI:1316380447
Name:STEPHENS, DUANE K (LAC)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:K
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5105 TOLLVIEW DR
Mailing Address - Street 2:SUITE #197
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3713
Mailing Address - Country:US
Mailing Address - Phone:224-735-3638
Mailing Address - Fax:224-735-3657
Practice Address - Street 1:5105 TOLLVIEW DR
Practice Address - Street 2:SUITE #197
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3713
Practice Address - Country:US
Practice Address - Phone:224-735-3638
Practice Address - Fax:224-735-3657
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL193001040171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist