Provider Demographics
NPI:1982743126
Name:STEPHANIE M MONROE D.C., P.C.
Entity Type:Organization
Organization Name:STEPHANIE M MONROE D.C., P.C.
Other - Org Name:RIVER BEND CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-467-2744
Mailing Address - Street 1:3302 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2558
Mailing Address - Country:US
Mailing Address - Phone:618-467-2744
Mailing Address - Fax:
Practice Address - Street 1:3302 GODFREY RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2558
Practice Address - Country:US
Practice Address - Phone:618-467-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL293662OtherHEALTHLINK
IN06021571OtherBLUE CROSS BLUE SHIELD IL
IL4400408OtherUHC
MO105211OtherBLUE SHIELD OF MO
IL5178160OtherAETNA
ILU59444Medicare UPIN
IL208405Medicare PIN