Healthcare Provider Details

I. General information

NPI: 1982112793
Provider Name (Legal Business Name): KEITH BEACHY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 CHENAL PARKWAY STE 120
LITTLE ROCK AR
72211-2297
US

IV. Provider business mailing address

15400 CHENAL PARKWAY STE 120
LITTLE ROCK AR
72211-2297
US

V. Phone/Fax

Practice location:
  • Phone: 501-400-7700
  • Fax: 501-244-3784
Mailing address:
  • Phone: 501-400-7700
  • Fax: 501-244-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16184
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: