Provider Demographics
NPI:1619068202
Name:BEEM, JEFFREY J (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:BEEM
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 1:215 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1429
Mailing Address - Country:US
Mailing Address - Phone:920-685-6788
Mailing Address - Fax:920-685-0293
Practice Address - Street 1:215 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1429
Practice Address - Country:US
Practice Address - Phone:920-685-6788
Practice Address - Fax:920-685-0293
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2327-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837400Medicaid