Provider Demographics
NPI:1669898045
Name:STONE, DAVID (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:SUITE 815
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-425-9120
Mailing Address - Fax:847-425-9125
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:SUITE 815
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4668
Practice Address - Country:US
Practice Address - Phone:847-425-9120
Practice Address - Fax:847-425-9125
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000532171100000X
IN84000058A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist