Provider Demographics
NPI:1578748034
Name:PHYSICIANS PLUS BERWYN LTD.
Entity Type:Organization
Organization Name:PHYSICIANS PLUS BERWYN LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-265-6908
Mailing Address - Street 1:205 W RANDOLPH ST
Mailing Address - Street 2:1205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-265-6908
Mailing Address - Fax:312-264-0347
Practice Address - Street 1:205 W RANDOLPH ST
Practice Address - Street 2:1205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1867
Practice Address - Country:US
Practice Address - Phone:312-265-6908
Practice Address - Fax:312-264-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009369111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01629928OtherBCBS
IL038009369Medicaid
ILK07289Medicare PIN