Provider Demographics
NPI:1083890487
Name:BEACON CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:BEACON CHIROPRACTIC CENTER, P.C.
Other - Org Name:ZIONSVILLE HOLISTIC CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-733-9630
Mailing Address - Street 1:1620 W OAK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1969
Mailing Address - Country:US
Mailing Address - Phone:317-733-9630
Mailing Address - Fax:317-733-9631
Practice Address - Street 1:1620 W OAK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1969
Practice Address - Country:US
Practice Address - Phone:317-733-9630
Practice Address - Fax:317-733-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000102A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256390AMedicaid
IN100256390AMedicaid