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Organization
STAKER CHIROPRACTIC LIFE CENTER P C
Active
Organization
STAKER CHIROPRACTIC LIFE CENTER P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYCE CURTIS STAKER D.C (PRESIDENT)
(630) 232-6616
Entity
Organization
Contact information
Practice address
501 LARK ST, GENEVA, IL 60134-2526
(630) 232-6616
(630) 232-6681
Mailing address
501 LARK ST, P. O. BOX 47, GENEVA, IL 60134-2526
(630) 232-6616
(630) 232-6681
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4522176
BLUE SHIELD GROUP NUMBER
IL
Enumeration date
08/05/2006
Last updated
11/14/2011
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