Provider Demographics
NPI:1437121878
Name:BEAUMONT, MARION EARL II (DC)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:EARL
Last Name:BEAUMONT
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4000 WAKE FOREST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6859
Mailing Address - Country:US
Mailing Address - Phone:919-871-0349
Mailing Address - Fax:919-871-0359
Practice Address - Street 1:1305 E MILLBROOK RD
Practice Address - Street 2:SUITE C101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5400
Practice Address - Country:US
Practice Address - Phone:919-871-0349
Practice Address - Fax:919-871-0359
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085N6OtherBLUE CROSS CLUE SHIELD
NC89085N6Medicaid
NC89085N6Medicaid
NC2456906Medicare PIN