Provider Demographics
NPI:1336530286
Name:BEACON HEALTH SOLUTIONS INC
Entity Type:Organization
Organization Name:BEACON HEALTH SOLUTIONS INC
Other - Org Name:BEACON OF LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-637-5064
Mailing Address - Street 1:70 BUCKWALTER RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1846
Mailing Address - Country:US
Mailing Address - Phone:810-637-5064
Mailing Address - Fax:
Practice Address - Street 1:70 BUCKWALTER RD
Practice Address - Street 2:SUITE 412
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1846
Practice Address - Country:US
Practice Address - Phone:810-637-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty