Provider Demographics
NPI:1548568108
Name:BEILBY CHIROPRACTIC AND WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:BEILBY CHIROPRACTIC AND WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BEILBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-633-9668
Mailing Address - Street 1:2780 SNELLING AVE N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7115
Mailing Address - Country:US
Mailing Address - Phone:651-633-9668
Mailing Address - Fax:651-633-4203
Practice Address - Street 1:2780 SNELLING AVE N
Practice Address - Street 2:SUITE 301
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7115
Practice Address - Country:US
Practice Address - Phone:651-633-9668
Practice Address - Fax:651-633-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty