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General NPI Number Information
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NPI Number | 1619326394
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE BRAIN AND BODY
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 5010 FAIRVIEW AVE STE 5
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5201
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Country | US
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Telephone | 810-516-0815
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 FAIRVIEW AVE STE 5
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5201
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Country | US
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Telephone | 810-516-0815
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SCOTT BEYER
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Credential | DC
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Telephone | 810-516-0815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.012653
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License Number State | IL
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