Provider Demographics
NPI:1841476611
Name:BEVERLY FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BEVERLY FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-445-0200
Mailing Address - Street 1:10735 S WESTERN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3155
Mailing Address - Country:US
Mailing Address - Phone:773-445-0200
Mailing Address - Fax:773-445-0700
Practice Address - Street 1:10735 S WESTERN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3156
Practice Address - Country:US
Practice Address - Phone:773-445-0200
Practice Address - Fax:773-445-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty