Provider Demographics
NPI:1811081938
Name:O'NEILL, STEPHANIE (BS, DC, DICCP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:BS, DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W 63RD ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1647
Mailing Address - Country:US
Mailing Address - Phone:563-359-1455
Mailing Address - Fax:
Practice Address - Street 1:2711 W 63RD ST
Practice Address - Street 2:SUITE #4
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1647
Practice Address - Country:US
Practice Address - Phone:563-359-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor