Provider Demographics
NPI:1376175893
Name:DESTEPHANO, LAUREN (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:DESTEPHANO
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N US HIGHWAY 12 STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8308
Mailing Address - Country:US
Mailing Address - Phone:815-675-0675
Mailing Address - Fax:
Practice Address - Street 1:2100 N US HIGHWAY 12 STE 101
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8308
Practice Address - Country:US
Practice Address - Phone:815-675-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013513111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology