Healthcare Provider Details

I. General information

NPI: 1811090491
Provider Name (Legal Business Name): BEYER CHIROPRACTIC CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17023 HARLEM AVE
TINLEY PARK IL
60477-2739
US

IV. Provider business mailing address

17023 HARLEM AVE
TINLEY PARK IL
60477-2739
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-1222
  • Fax: 708-614-0470
Mailing address:
  • Phone: 708-614-1222
  • Fax: 708-614-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006095
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-013809
License Number StateIL

VIII. Authorized Official

Name: DR. EDWARD J. BEYER
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 708-614-1222