Provider Demographics
NPI:1790870038
Name:BEAUCHAMP, DAVID ELLIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIS
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 1:3706 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4204
Mailing Address - Country:US
Mailing Address - Phone:815-626-6357
Mailing Address - Fax:815-626-6376
Practice Address - Street 1:3706 RIVER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-4204
Practice Address - Country:US
Practice Address - Phone:815-626-6357
Practice Address - Fax:815-626-6376
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL988-2010OtherBC/BS OF IL
IL988-2010OtherBC/BS OF IL