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Organization
BEVERLY BONE AND JOINT CLINIC LLC
Active
Organization
BEVERLY BONE AND JOINT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN SMITH (BILLER)
(810) 358-8749
Entity
Organization
Contact information
Practice address
10448 S WESTERN AVE, CHICAGO, IL 60643-2508
(708) 360-3507
Mailing address
10448 S WESTERN AVE, CHICAGO, IL 60643-2508
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
207L00000X
Anesthesiology Physician
—
NULL
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
10/19/2023
Last updated
10/26/2023
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