Provider Demographics
NPI:1184682080
Name:BEAMON, KRISTIN MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:BEAMON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3156
Mailing Address - Country:US
Mailing Address - Phone:308-630-0551
Mailing Address - Fax:308-630-0559
Practice Address - Street 1:24 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3156
Practice Address - Country:US
Practice Address - Phone:308-630-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024971700Medicaid
NEU95143Medicare UPIN
NE10024971700Medicaid