Provider Demographics
NPI:1346847993
Name:DR. BEAU CASEY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DR. BEAU CASEY CHIROPRACTIC, LLC
Other - Org Name:THE-BACK.SPACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-818-3373
Mailing Address - Street 1:678 WHARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1189
Mailing Address - Country:US
Mailing Address - Phone:619-987-6255
Mailing Address - Fax:
Practice Address - Street 1:678 WHARTON BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1189
Practice Address - Country:US
Practice Address - Phone:619-987-6255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty