Provider Demographics
NPI:1093836371
Name:BEACHY, MATTHEW J (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:BEACHY
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 1:751 MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-1280
Mailing Address - Country:US
Mailing Address - Phone:419-886-7007
Mailing Address - Fax:419-886-2080
Practice Address - Street 1:751 MILL RD
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-1280
Practice Address - Country:US
Practice Address - Phone:419-886-7007
Practice Address - Fax:419-886-2080
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492904Medicaid
OH4138901Medicare ID - Type UnspecifiedMEDICARE ID#