Provider Demographics
NPI:1528380656
Name:BEALL, JOHN SPENCER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SPENCER
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 1:1055 COWPER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3215
Mailing Address - Country:US
Mailing Address - Phone:510-205-9539
Mailing Address - Fax:
Practice Address - Street 1:1226 PARK ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5212
Practice Address - Country:US
Practice Address - Phone:510-205-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor