Provider Demographics
NPI:1144378506
Name:OMRO CHIROPRACTIC OFFICE, SC
Entity Type:Organization
Organization Name:OMRO CHIROPRACTIC OFFICE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-685-6788
Mailing Address - Street 1:215 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1429
Mailing Address - Country:US
Mailing Address - Phone:920-685-6788
Mailing Address - Fax:920-685-0293
Practice Address - Street 1:215 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1429
Practice Address - Country:US
Practice Address - Phone:920-685-6788
Practice Address - Fax:920-685-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2327 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty