MEDICARE: BODY BEYOND CHIROPRACTIC AND WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

General Provider Information

NPI Number	:	1952525826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY BEYOND CHIROPRACTIC AND WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	3258 N RACINE AVE
Second Line	:	2
City	:	CHICAGO
State	:	IL
Zip	:	60657-3322
Country	:	US
Telephone Number	:	773-931-6578
Fax Number	:	708-788-5620

Provider Business Practice Location Address
First Line	:	3258 N RACINE AVE
Second Line	:	2
City	:	CHICAGO
State	:	IL
Zip	:	60657-3322
Country	:	US
Telephone Number	:	773-931-6578
Fax Number	:	708-788-5620

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. CHRISTOPHER KIRKWOOD EDGINTON
Credential	:	D.C.
Telephone Number	:	773-931-6578

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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