Provider Demographics
NPI:1821119934
Name:BEAUCHAMP, TRAVIS (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
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 1:1810 WEBSTER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9305
Mailing Address - Country:US
Mailing Address - Phone:715-386-6100
Mailing Address - Fax:715-386-6298
Practice Address - Street 1:1810 WEBSTER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9305
Practice Address - Country:US
Practice Address - Phone:715-386-6100
Practice Address - Fax:715-386-6298
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4935111N00000X
WI4313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046N7BEOtherBLUE CROSS AND BLUE SHIELD OF MINNESOTA
WI38976700Medicaid
WI38976700Medicaid