Provider Demographics
NPI:1255431599
Name:BEYERS, WILFRED C (DC)
Entity type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:C
Last Name:BEYERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 45
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-9607
Mailing Address - Country:US
Mailing Address - Phone:217-562-9214
Mailing Address - Fax:217-562-4771
Practice Address - Street 1:RR 1 BOX 45
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-9607
Practice Address - Country:US
Practice Address - Phone:217-562-9214
Practice Address - Fax:217-562-4771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1115002OtherBLUE CROSS BLUE SHIELD
IL1115002OtherBLUE CROSS BLUE SHIELD