Provider Demographics
NPI:1821208810
Name:SCOTTSBLUFF FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SCOTTSBLUFF FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BEAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-630-0551
Mailing Address - Street 1:24 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3156
Mailing Address - Country:US
Mailing Address - Phone:308-630-0551
Mailing Address - Fax:
Practice Address - Street 1:24 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3156
Practice Address - Country:US
Practice Address - Phone:308-630-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100249717-00Medicaid
NE0099361Medicare PIN
NEU95143Medicare UPIN