Provider Demographics
NPI:1386862837
Name:BEALS, MARC HARRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:HARRIS
Last Name:BEALS
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 1:28107 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2810
Mailing Address - Country:US
Mailing Address - Phone:586-722-4117
Mailing Address - Fax:248-542-3494
Practice Address - Street 1:28107 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2810
Practice Address - Country:US
Practice Address - Phone:586-722-4117
Practice Address - Fax:248-542-3494
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E05071OtherBLUE CROSS
MI1700925Medicaid
MI107354OtherGREAT LAKES HEALTH PLAN
MIP26303FOtherBLUE CARE NETWORK
MI0E05071Medicare ID - Type Unspecified