Healthcare Provider Details

I. General information

NPI: 1700107653
Provider Name (Legal Business Name): TERRI LYNN BEDNAR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N UNION ST
YATES CITY IL
61572-9344
US

IV. Provider business mailing address

400 N UNION ST
YATES CITY IL
61572-9344
US

V. Phone/Fax

Practice location:
  • Phone: 309-224-4701
  • Fax:
Mailing address:
  • Phone: 309-224-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: