MEDICARE: BEOM CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00661000	NJ

General Provider Information

NPI Number	:	1033383294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEOM CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	605 BOSTON BLVD
Second Line	:
City	:	SEA GIRT
State	:	NJ
Zip	:	08750-2510
Country	:	US
Telephone Number	:	714-588-0963
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 GLOBE CT
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1824
Country	:	US
Telephone Number	:	732-345-1377
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN E. O'MULLAN
Credential	:	D.C.
Telephone Number	:	714-588-0963

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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