Provider Demographics
NPI:1306851852
Name:BEUCKMAN, BARBARA A (DO)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:BEUCKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:THURWALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5504
Mailing Address - Country:US
Mailing Address - Phone:618-277-6260
Mailing Address - Fax:618-227-6278
Practice Address - Street 1:4401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5504
Practice Address - Country:US
Practice Address - Phone:618-277-6260
Practice Address - Fax:618-227-6278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL669260Medicare ID - Type Unspecified
ILT37652Medicare UPIN