Provider Demographics
NPI:1255049607
Name:BEECHER, SAMUEL CRAIG
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CRAIG
Last Name:BEECHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 DELAWARE ST APT 21
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3318
Mailing Address - Country:US
Mailing Address - Phone:785-551-2485
Mailing Address - Fax:
Practice Address - Street 1:401 ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1338
Practice Address - Country:US
Practice Address - Phone:785-551-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCL-29581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty