Provider Demographics
NPI:1972604031
Name:DOUBLEDAY, BEAU DUSTIN (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:DUSTIN
Last Name:DOUBLEDAY
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S SHORE DR
Mailing Address - Street 2:UNIT 121
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5440
Mailing Address - Country:US
Mailing Address - Phone:269-963-3072
Mailing Address - Fax:269-963-3085
Practice Address - Street 1:601 S SHORE DR
Practice Address - Street 2:UNIT 121
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5440
Practice Address - Country:US
Practice Address - Phone:269-963-3072
Practice Address - Fax:269-963-3072
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009208111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4978299Medicaid
MI4978299Medicaid
MIP39110002Medicare PIN