Provider Demographics
NPI:1902822349
Name:CHIROPRACTIC CARE CENTER OF BELOIT, SC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER OF BELOIT, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-362-7652
Mailing Address - Street 1:654 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6156
Mailing Address - Country:US
Mailing Address - Phone:608-362-7652
Mailing Address - Fax:
Practice Address - Street 1:654 BLUFF ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6156
Practice Address - Country:US
Practice Address - Phone:608-362-7652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========013OtherBLUE CROSS BLUE SHIELD
WI=========013OtherBLUE CROSS BLUE SHIELD