Provider Demographics
NPI:1437254489
Name:BEAN, CURTIS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WAYNE
Last Name:BEAN
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 1:7409 WOODRIDGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2249
Mailing Address - Country:US
Mailing Address - Phone:630-963-1212
Mailing Address - Fax:630-963-1594
Practice Address - Street 1:7409 WOODRIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2249
Practice Address - Country:US
Practice Address - Phone:630-963-1212
Practice Address - Fax:630-963-1594
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38721Medicare UPIN
763690Medicare ID - Type Unspecified