Organization
DR. STEPHANIE LACEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY PENDOLINO D.C. (MANAGING MEMBER)
(630) 961-2848
Entity
Organization
Contact information
Practice address
148 N WASHINGTON ST, NAPERVILLE, IL 60540-4512
(630) 961-2848
Mailing address
148 N WASHINGTON ST, NAPERVILLE, IL 60540-4512
(630) 961-2848
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-007426
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350044698
RAILROAD MEDICARE
IL
Enumeration date
12/05/2007
Last updated
07/21/2014
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