Provider Demographics
NPI:1164932752
Name:BEAMER, DYLAN JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JONATHAN
Last Name:BEAMER
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 1:1210 PUGET ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2144
Mailing Address - Country:US
Mailing Address - Phone:503-806-7558
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKEWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2034
Practice Address - Country:US
Practice Address - Phone:503-806-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60784950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor