Provider Demographics
NPI:1215330600
Name:BEARDEN FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BEARDEN FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-401-8373
Mailing Address - Street 1:31207 KEATS WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2220
Mailing Address - Country:US
Mailing Address - Phone:720-328-1963
Mailing Address - Fax:720-287-3242
Practice Address - Street 1:31207 KEATS WAY STE 203
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2220
Practice Address - Country:US
Practice Address - Phone:720-328-1963
Practice Address - Fax:720-287-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty