Provider Demographics
NPI:1629348990
Name:MARC H BEALS DC PC.
Entity Type:Organization
Organization Name:MARC H BEALS DC PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BEALS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-977-3200
Mailing Address - Street 1:33142 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33142 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5914
Practice Address - Country:US
Practice Address - Phone:586-977-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33332OtherMEDICARE PROVIDER # 0E05071
MI0 E 050710OtherBLUE CROSS BLUE SHIELD
MI1700925Medicaid