Provider Demographics
NPI:1376688101
Name:BON-BEAM, SANDRA KATARINA (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KATARINA
Last Name:BON-BEAM
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 1:602 CANDLEWOOD CMNS
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2173
Mailing Address - Country:US
Mailing Address - Phone:732-901-3001
Mailing Address - Fax:732-901-3105
Practice Address - Street 1:55 SCHANCK RD
Practice Address - Street 2:STE B-19
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3067
Practice Address - Country:US
Practice Address - Phone:732-294-0004
Practice Address - Fax:732-294-0438
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00475200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6701302Medicaid
BO 799812Medicare ID - Type Unspecified
U59253Medicare UPIN