Provider Demographics
NPI:1235208554
Name:BEACH, NADINE S (DC)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:S
Last Name:BEACH
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 1:21 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1605
Mailing Address - Country:US
Mailing Address - Phone:631-650-9113
Mailing Address - Fax:
Practice Address - Street 1:972 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6110
Practice Address - Country:US
Practice Address - Phone:631-422-6675
Practice Address - Fax:631-422-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010939-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor