Provider Demographics
NPI:1538103932
Name:BEARD, DANIEL R (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:BEARD
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 1:440E ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1414
Mailing Address - Country:US
Mailing Address - Phone:608-742-2333
Mailing Address - Fax:608-742-5663
Practice Address - Street 1:440 E ALBERT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1414
Practice Address - Country:US
Practice Address - Phone:608-742-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3336-012111N00000X
WI3336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38898800Medicaid
WIU63275Medicare UPIN