Provider Demographics
NPI:1700982865
Name:BEACOM, BRENT RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:RICHARD
Last Name:BEACOM
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 1:923 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1203
Mailing Address - Country:US
Mailing Address - Phone:231-893-1744
Mailing Address - Fax:231-893-6637
Practice Address - Street 1:923 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1203
Practice Address - Country:US
Practice Address - Phone:231-893-1744
Practice Address - Fax:231-893-6637
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F150400OtherBCBS