Provider Demographics
NPI:1912076316
Name:STILES, TRACEY DENISE (DC)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:DENISE
Last Name:STILES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3816
Mailing Address - Country:US
Mailing Address - Phone:312-642-1138
Mailing Address - Fax:312-642-1349
Practice Address - Street 1:658 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3816
Practice Address - Country:US
Practice Address - Phone:312-642-1138
Practice Address - Fax:312-642-1349
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006300111NI0900X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605840OtherBLUE CROSS BLUE SHIELD
IL1605840OtherBLUE CROSS BLUE SHIELD