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General NPI Number Information
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NPI Number | 1164749727
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Entity Type | Organization
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Legal Business Name | DR. RAY BEACH PC
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 300 W 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2547
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Country | US
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Telephone | 402-721-1190
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Fax | 402-721-1199
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Provider Business Mailing Address
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Address Line | 300 W 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2547
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Country | US
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Telephone | 402-721-1190
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Fax | 402-721-1199
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. RAY M BEACH
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Credential | PC
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Telephone | 402-721-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 480
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License Number State | NE
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