Provider Demographics
NPI:1013173749
Name:BEALE FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BEALE FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-883-5730
Mailing Address - Street 1:22323 SHERMAN WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4302
Mailing Address - Country:US
Mailing Address - Phone:818-883-5730
Mailing Address - Fax:818-883-1689
Practice Address - Street 1:22323 SHERMAN WAY STE 4
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4302
Practice Address - Country:US
Practice Address - Phone:818-883-5730
Practice Address - Fax:818-883-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19046261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19046Medicare PIN