Provider Demographics
NPI:1093721268
Name:BEARD, JAMES P (D C)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:BEARD
Suffix:
Gender:M
Credentials:D C
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:P
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D C P A
Mailing Address - Street 1:1920 W BAY DR STE 1
Mailing Address - Street 2:1560 PARKVIEW LANE (HOME)
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3022
Mailing Address - Country:US
Mailing Address - Phone:727-581-8888
Mailing Address - Fax:727-581-8888
Practice Address - Street 1:1920 W BAY DR STE 1
Practice Address - Street 2:1560 PARKVIEW LANE (HOME)
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3022
Practice Address - Country:US
Practice Address - Phone:727-581-8888
Practice Address - Fax:727-581-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88496Medicare ID - Type UnspecifiedPROVIDER NUMBER