Provider Demographics
NPI:1962418152
Name:BEAULIEU, BRITTIN A (DC)
Entity type:Individual
Prefix:
First Name:BRITTIN
Middle Name:A
Last Name:BEAULIEU
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 1:2171 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2529
Mailing Address - Country:US
Mailing Address - Phone:727-272-0501
Mailing Address - Fax:
Practice Address - Street 1:2288 DREW ST STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3307
Practice Address - Country:US
Practice Address - Phone:727-272-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002280A111N00000X
FLCH10085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200843480Medicaid
IN133490IMedicare PIN
INV10720Medicare UPIN