Provider Demographics
NPI:1619326394
Name:INTEGRATIVE BRAIN AND BODY
Entity Type:Organization
Organization Name:INTEGRATIVE BRAIN AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-516-0815
Mailing Address - Street 1:5010 FAIRVIEW AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5201
Mailing Address - Country:US
Mailing Address - Phone:810-516-0815
Mailing Address - Fax:
Practice Address - Street 1:5010 FAIRVIEW AVE STE 5
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5201
Practice Address - Country:US
Practice Address - Phone:810-516-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038.012653OtherLICENSE NUMBER