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General NPI Number Information
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NPI Number | 1639644222
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Entity Type | Individual
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Provider Name | BEAU BLAKELEY DC
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Gender | Male
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 320 W BURLINGTON AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2363
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Country | US
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Telephone | 708-497-2441
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Fax |
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Provider Business Mailing Address
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Address Line | 320 W BURLINGTON AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2363
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Country | US
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Telephone | 708-497-2441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 038013267
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License Number State | IL
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