Provider Demographics
NPI:1366201287
Name:STEWART, MADISON ELAINE (DC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELAINE
Last Name:STEWART
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 1:6135 N KNOLL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-3420
Mailing Address - Country:US
Mailing Address - Phone:309-299-4192
Mailing Address - Fax:
Practice Address - Street 1:387 OLD GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN HILLS
Practice Address - State:IL
Practice Address - Zip Code:61548-8679
Practice Address - Country:US
Practice Address - Phone:309-383-2772
Practice Address - Fax:309-383-2773
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.14142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor