Provider Demographics
NPI:1356444954
Name:BEYERS, MATTHEW TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TODD
Last Name:BEYERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 W NORTH FIRST ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565
Mailing Address - Country:US
Mailing Address - Phone:217-774-5313
Mailing Address - Fax:217-774-5314
Practice Address - Street 1:1117 W NORTH FIRST ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-5313
Practice Address - Fax:217-774-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8715006OtherBLUE CROSS BLUE SHIELD
ILK25872Medicare PIN