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General NPI Number Information
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NPI Number | 1649052002
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Entity Type | Organization
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Legal Business Name | BEVERLY BONE AND JOINT CLINIC LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 10448 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2508
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Country | US
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Telephone | 708-360-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 10448 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | NATHAN SMITH
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Credential |
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Telephone | 810-358-8749
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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