Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 227.016877 | IL |
NPI | 1013323849 |
---|---|
Provider Name | Ms. Kendra Shana' Stewart |
First Address | Normal, IL 61761-3077 |
Second Address | Normal, IL 61761-3077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 01/07/2014 |