Provider Demographics
NPI:1750687141
Name:BEALL, PATRICIA MIKELA (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MIKELA
Last Name:BEALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:DENARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:334 LOCUST THORN CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1858
Mailing Address - Country:US
Mailing Address - Phone:607-280-0245
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-431-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDS03706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty