Provider Demographics
NPI:1962609867
Name:DAVID E. BEAUCHAMP, D.C., P.C.
Entity type:Organization
Organization Name:DAVID E. BEAUCHAMP, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:P.C., PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-626-6357
Mailing Address - Street 1:3706 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4204
Mailing Address - Country:US
Mailing Address - Phone:815-626-6357
Mailing Address - Fax:815-626-6376
Practice Address - Street 1:3706 RIVER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-4204
Practice Address - Country:US
Practice Address - Phone:815-626-6357
Practice Address - Fax:815-626-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL988-2010OtherBC BS OF IL
IL1790870038OtherPROVIDER NPI
IL988-2010OtherBC BS OF IL