Provider Demographics
NPI:1811090491
Name:BEYER CHIROPRACTIC CLINIC SC
Entity type:Organization
Organization Name:BEYER CHIROPRACTIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-614-1222
Mailing Address - Street 1:17023 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2739
Mailing Address - Country:US
Mailing Address - Phone:708-614-1222
Mailing Address - Fax:708-614-0470
Practice Address - Street 1:17023 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2739
Practice Address - Country:US
Practice Address - Phone:708-614-1222
Practice Address - Fax:708-614-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013809225100000X
IL038-006095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209444Medicare ID - Type UnspecifiedMEDICARE FOR P.T.
IL780230Medicare ID - Type Unspecified
T39012Medicare UPIN