Dr Beau Blakeley, DC | |
320 W Burlington Ave, La Grange, IL 60525-2363 | |
(708) 497-2441 | |
Not Available |
Full Name | Dr Beau Blakeley |
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Gender | Male |
Speciality | Chiropractor - Neurology |
Location | 320 W Burlington Ave, La Grange, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1639644222 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111NN0400X | Chiropractor - Neurology | 038013267 (Illinois) | Secondary |
Provider Name | Suvarna Chiropractic Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1255889317 PECOS PAC ID: 1355639394 Enrollment ID: O20161007000323 |
Provider Name | Suvarna Chiropractic 2 Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1154865665 PECOS PAC ID: 8820379647 Enrollment ID: O20170110000244 |
Mailing Address | Practice Location Address |
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Dr Beau Blakeley, DC 320 W Burlington Ave, La Grange, IL 60525-2363 Ph: (708) 497-2441 | Dr Beau Blakeley, DC 320 W Burlington Ave, La Grange, IL 60525-2363 Ph: (708) 497-2441 |
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