Provider Demographics
NPI:1720038128
Name:STACHNIK, KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:STACHNIK
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 1:1207 S MATTIS AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-4861
Mailing Address - Country:US
Mailing Address - Phone:309-745-8426
Mailing Address - Fax:
Practice Address - Street 1:1207 S MATTIS AVE
Practice Address - Street 2:STE 2
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4861
Practice Address - Country:US
Practice Address - Phone:309-661-0414
Practice Address - Fax:309-661-8697
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor