Provider Demographics
NPI:1740322866
Name:SIDNEY BEAN CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:SIDNEY BEAN CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-475-1263
Mailing Address - Street 1:1754 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6613
Mailing Address - Country:US
Mailing Address - Phone:916-475-1263
Mailing Address - Fax:916-475-1863
Practice Address - Street 1:1754 36TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6613
Practice Address - Country:US
Practice Address - Phone:916-475-1263
Practice Address - Fax:916-475-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC02834200Medicare UPIN
CAU95035Medicare UPIN