Provider Demographics
NPI:1366535098
Name:LACEY, STEPHANIE SUSAN (DC, DIPL ACUP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUSAN
Last Name:LACEY
Suffix:
Gender:F
Credentials:DC, DIPL ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-961-2848
Mailing Address - Fax:630-961-2918
Practice Address - Street 1:148 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-961-2848
Practice Address - Fax:630-961-2918
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007426111N00000X
IL198-00375171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL318-6170OtherCIGNA
IL022-05753OtherBC/BS
IL5538693OtherAENTA
IL350044698OtherRAILROAD MEDICARE
IL022-05753OtherBC/BS
IL212493Medicare ID - Type UnspecifiedMEDICARE #