Healthcare Provider Details

I. General information

NPI: 1083890487
Provider Name (Legal Business Name): BEACON CHIROPRACTIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EXECUTIVE DR STE J
CARMEL IN
46032-2993
US

IV. Provider business mailing address

75 EXECUTIVE DR STE J
CARMEL IN
46032-2993
US

V. Phone/Fax

Practice location:
  • Phone: 317-733-9630
  • Fax: 317-733-9631
Mailing address:
  • Phone: 317-733-9630
  • Fax: 317-733-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number51000102A
License Number StateIN

VIII. Authorized Official

Name: GERALD L. WHALEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 317-733-9630