Provider Demographics
NPI:1700093432
Name:AMANDA B BEEVER PC
Entity Type:Organization
Organization Name:AMANDA B BEEVER PC
Other - Org Name:TRI STATE CLINIC NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BEEVER
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-265-1366
Mailing Address - Street 1:520 CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405
Mailing Address - Country:US
Mailing Address - Phone:423-265-1366
Mailing Address - Fax:423-265-1390
Practice Address - Street 1:520 CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405
Practice Address - Country:US
Practice Address - Phone:423-265-1366
Practice Address - Fax:423-265-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4099296OtherBCBS
U73932Medicare UPIN
3970240Medicare ID - Type Unspecified