Provider Demographics
NPI:1902034911
Name:BEAL, KENDRA S (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:S
Last Name:BEAL
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 1:18055 BUSHARD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5760
Mailing Address - Country:US
Mailing Address - Phone:714-546-3472
Mailing Address - Fax:714-784-7811
Practice Address - Street 1:18055 BUSHARD ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5760
Practice Address - Country:US
Practice Address - Phone:714-546-3472
Practice Address - Fax:714-784-7811
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC30984OtherSTATE LICENSE NUMBER