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Organization
GOLD COAST OSTEOPATHIC, PSC
Active
Organization
GOLD COAST OSTEOPATHIC, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AIDA BECKERLY (PRESIDENT)
(773) 553-6055
Entity
Organization
Contact information
Practice address
680 N LAKE SHORE DR, SUITE 1040, CHICAGO, IL 60611-4546
(773) 554-6055
Mailing address
680 N LAKE SHORE DR STE 1040, CHICAGO, IL 60611-8718
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
02004367B
IN
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
243290
MA
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
261752
NY
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
IL
207Q00000X
Family Medicine Physician
02004367A
IN
207Q00000X
Family Medicine Physician
243290
MA
207Q00000X
Family Medicine Physician
261752
NY
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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