Provider Demographics
NPI:1831682848
Name:DEVIN BEACH DC PLLC
Entity type:Organization
Organization Name:DEVIN BEACH DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:REG
Authorized Official - Middle Name:OLLIE
Authorized Official - Last Name:OVERMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-987-1304
Mailing Address - Street 1:18 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3504
Mailing Address - Country:US
Mailing Address - Phone:845-782-5770
Mailing Address - Fax:845-782-9061
Practice Address - Street 1:18 LAKE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3504
Practice Address - Country:US
Practice Address - Phone:845-782-5770
Practice Address - Fax:845-782-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty