Provider Demographics
NPI:1558318709
Name:BEGUELIN, EDIE (DC)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:
Last Name:BEGUELIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E SILVER SPRING DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5274
Mailing Address - Country:US
Mailing Address - Phone:414-962-9880
Mailing Address - Fax:
Practice Address - Street 1:316 E SILVER SPRING DR
Practice Address - Street 2:SUITE 301
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5274
Practice Address - Country:US
Practice Address - Phone:414-962-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T61457Medicare UPIN
WI000070964Medicare PIN