=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306402144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDRO JAIME BEAUCHAMP III DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2019
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9630 SHERRILL ESTATES RD STE B
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-6551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-947-7272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 S GRAHAM ST APT 406
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-3240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-646-5995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4956
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------