Provider Demographics
NPI:1386732311
Name:BALDWIN, STACIE M (DC)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:STACIE
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:313 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:GRAYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62844-1824
Mailing Address - Country:US
Mailing Address - Phone:618-384-8592
Mailing Address - Fax:
Practice Address - Street 1:319 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GRAYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62844-1565
Practice Address - Country:US
Practice Address - Phone:618-375-9992
Practice Address - Fax:618-375-9991
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35-2268554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor