Provider Demographics
NPI:1851340830
Name:BEAM, LISETTE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:ANN
Last Name:BEAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2248
Mailing Address - Country:US
Mailing Address - Phone:760-619-5795
Mailing Address - Fax:
Practice Address - Street 1:2205 N VALLEY DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2248
Practice Address - Country:US
Practice Address - Phone:760-619-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010427111N00000X
CADC31054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4544951OtherBCBS PROVIDER#
CA752842363OtherTAX ID
NY562335358OtherTAX ID
NYC104275WOtherWORKERS COMPENSATION
NYU83959Medicare UPIN
NYRA0618Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
483959Medicare UPIN