Provider Demographics
NPI:1417299710
Name:BEDNAR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BEDNAR CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEDNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-224-4701
Mailing Address - Street 1:1113 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4921
Mailing Address - Country:US
Mailing Address - Phone:309-349-3747
Mailing Address - Fax:309-349-3746
Practice Address - Street 1:1113 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4921
Practice Address - Country:US
Practice Address - Phone:309-349-3747
Practice Address - Fax:309-349-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7397OtherMEDICARE PTAN