Provider Demographics
NPI:1073757811
Name:BEYER CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:BEYER CHIROPRACTIC CENTER P.C.
Other - Org Name:BEYER FUNCTIONAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-478-0690
Mailing Address - Street 1:10012 W 190TH PL
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8752
Mailing Address - Country:US
Mailing Address - Phone:708-478-0690
Mailing Address - Fax:708-400-7949
Practice Address - Street 1:10012 W 190TH PL BLDG A
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8752
Practice Address - Country:US
Practice Address - Phone:708-478-0690
Practice Address - Fax:708-400-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007483111N00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty