Provider Demographics
NPI:1073619136
Name:BEACOM FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BEACOM FAMILY CHIROPRACTIC PC
Other - Org Name:BEACOM FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BEACOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-893-1744
Mailing Address - Street 1:923 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1203
Mailing Address - Country:US
Mailing Address - Phone:231-893-1744
Mailing Address - Fax:231-893-6637
Practice Address - Street 1:923 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1203
Practice Address - Country:US
Practice Address - Phone:231-893-1744
Practice Address - Fax:231-893-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950F150400OtherBCBS
OP25760Medicare ID - Type Unspecified