Provider Demographics
NPI:1710057401
Name:BEAUCHAMP, JAMES WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:BEAUCHAMP
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 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:
Practice Address - Street 1:3261 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 2011
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3223
Practice Address - Country:US
Practice Address - Phone:301-396-9305
Practice Address - Fax:301-396-9309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK4510001OtherBCBS FOR WASH DC
763BOtherMARYLAND BCBS
K4510001OtherBCBS FEDERAL
1141701OtherANOTHER AETNA #
325540OtherPHCS INS. #
672779OtherACN PROVIDER NUMBER
MDS01678OtherCHIROPRACTIC LICENSE
10434460OtherCAQH ID NUMBER
7365788OtherAETNA OTHER #'S
1551638OtherFIRST HEALTH INS
1323843OtherAETNA
1551638OtherFIRST HEALTH INS
MDS01678OtherCHIROPRACTIC LICENSE
219QMedicare ID - Type Unspecified