Provider Demographics
NPI:1548512742
Name:BEMIS FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BEMIS FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BEMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-433-9333
Mailing Address - Street 1:230 REGIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-433-9333
Mailing Address - Fax:618-433-9663
Practice Address - Street 1:230 REGIONAL DR.
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-433-9333
Practice Address - Fax:618-433-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008175111N00000X
IL038.00841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7741Medicare PIN
K35900, K35899Medicare PIN