Provider Demographics
NPI:1336327105
Name:SHOOK, STEPHANIE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:KAY
Last Name:SHOOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:211 S PERRINE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3635
Mailing Address - Country:US
Mailing Address - Phone:618-533-2225
Mailing Address - Fax:
Practice Address - Street 1:211 S PERRINE AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3635
Practice Address - Country:US
Practice Address - Phone:307-760-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY676111N00000X
IL038.011048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW22350OtherMEDICARE PTAN