Provider Demographics
NPI:1871224642
Name:BEARDED CHIRO INC.
Entity Type:Organization
Organization Name:BEARDED CHIRO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SRONKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-261-0001
Mailing Address - Street 1:442 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4630
Mailing Address - Country:US
Mailing Address - Phone:630-261-0001
Mailing Address - Fax:331-200-3123
Practice Address - Street 1:442 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4630
Practice Address - Country:US
Practice Address - Phone:630-261-0001
Practice Address - Fax:331-200-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty