Provider Demographics
NPI:1417354382
Name:BEACH, DEVIN
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:
Last Name:BEACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3504
Mailing Address - Country:US
Mailing Address - Phone:845-782-5770
Mailing Address - Fax:845-782-9061
Practice Address - Street 1:18 LAKE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-782-5770
Practice Address - Fax:845-782-9061
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03819111N00000X
NYX013068-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor