Provider Demographics
NPI:1558350157
Name:BEAN, SIDNEY B (DC)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:B
Last Name:BEAN
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 1:1754 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6613
Mailing Address - Country:US
Mailing Address - Phone:916-475-1263
Mailing Address - Fax:916-475-1863
Practice Address - Street 1:1754 36TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6613
Practice Address - Country:US
Practice Address - Phone:916-475-1263
Practice Address - Fax:916-475-1863
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 283420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC02834200Medicare ID - Type UnspecifiedMEDICARE
CAU95035Medicare UPIN