Healthcare Provider Details

I. General information

NPI: 1346511284
Provider Name (Legal Business Name): SAMUEL ALLEN BEUGELSDIJK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 WILLIAMS ST
GREAT BEND KS
67530-4447
US

IV. Provider business mailing address

1309 WILLIAMS ST
GREAT BEND KS
67530-4447
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-3678
  • Fax: 620-792-3670
Mailing address:
  • Phone: 620-792-3678
  • Fax: 620-792-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05454
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: