Provider Demographics
NPI:1245515071
Name:STONE, LAURA LETICIA (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LETICIA
Last Name:STONE
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 1:115 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61275-9751
Mailing Address - Country:US
Mailing Address - Phone:309-781-4362
Mailing Address - Fax:
Practice Address - Street 1:510 STATE AVE
Practice Address - Street 2:3
Practice Address - City:HAMPTON
Practice Address - State:IL
Practice Address - Zip Code:61256-9690
Practice Address - Country:US
Practice Address - Phone:309-751-9790
Practice Address - Fax:309-751-9792
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011910111N00000X
IA007405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor