Provider Demographics
NPI:1033383294
Name:BEOM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BEOM CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-588-0963
Mailing Address - Street 1:605 BOSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2510
Mailing Address - Country:US
Mailing Address - Phone:714-588-0963
Mailing Address - Fax:
Practice Address - Street 1:7 GLOBE CT
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1824
Practice Address - Country:US
Practice Address - Phone:732-345-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00661000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty