Provider Demographics
NPI:1235495433
Name:BEALL, MICHAEL LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEIGH
Last Name:BEALL
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:PO BOX 2313
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-2313
Mailing Address - Country:US
Mailing Address - Phone:253-740-6127
Mailing Address - Fax:
Practice Address - Street 1:766 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321
Practice Address - Country:US
Practice Address - Phone:253-740-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60268646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor