Provider Demographics
NPI:1821274796
Name:BETH ANN MCKEE, D.C.
Entity Type:Organization
Organization Name:BETH ANN MCKEE, D.C.
Other - Org Name:LACON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-246-2566
Mailing Address - Street 1:1109 FIFTH ST
Mailing Address - Street 2:P.O. BOX 226
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540-0226
Mailing Address - Country:US
Mailing Address - Phone:309-246-2566
Mailing Address - Fax:
Practice Address - Street 1:1109 FIFTH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-0226
Practice Address - Country:US
Practice Address - Phone:309-246-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497863997OtherTYPE I NPI
IL6282002OtherBC/BS
IL038006723OtherSTATE LICENSE
IL038006723Medicaid
IL6282002OtherBC/BS
ILU09397Medicare UPIN