Provider Demographics
NPI:1083897524
Name:BEARD, JOHN M (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BEARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-5193 KINOHOU ST
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8446
Mailing Address - Country:US
Mailing Address - Phone:808-885-1080
Mailing Address - Fax:808-885-1080
Practice Address - Street 1:64-5193 KINOHOU ST
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8446
Practice Address - Country:US
Practice Address - Phone:808-885-1080
Practice Address - Fax:808-885-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor