Provider Demographics
NPI:1619161213
Name:GILES, STEWART R (DC)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:R
Last Name:GILES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2803
Mailing Address - Country:US
Mailing Address - Phone:847-367-7463
Mailing Address - Fax:847-367-7464
Practice Address - Street 1:207 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2803
Practice Address - Country:US
Practice Address - Phone:847-367-7463
Practice Address - Fax:847-367-7464
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL388020Medicare UPIN