Provider Demographics
NPI:1912002932
Name:BEAULIEU, BROOKS L (DC)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:L
Last Name:BEAULIEU
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 1:910 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-2138
Mailing Address - Country:US
Mailing Address - Phone:954-570-7699
Mailing Address - Fax:954-570-7698
Practice Address - Street 1:910 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-2138
Practice Address - Country:US
Practice Address - Phone:954-570-7699
Practice Address - Fax:954-570-7698
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55997ZMedicare ID - Type UnspecifiedMEDICARE
FLU79931Medicare UPIN