Provider Demographics
NPI:1659479715
Name:BEAN, ROBERT DEWEY (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEWEY
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 1:625 N 5TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5062
Mailing Address - Country:US
Mailing Address - Phone:360-681-2414
Mailing Address - Fax:360-681-7239
Practice Address - Street 1:625 N 5TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5062
Practice Address - Country:US
Practice Address - Phone:360-681-2414
Practice Address - Fax:360-681-7239
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026219Medicaid
WA2026219Medicaid
WAG8801345Medicare PIN