MEDICARE: DR. RAY BEACH PC

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	480	NE

General Provider Information

NPI Number	:	1164749727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RAY BEACH PC

Provider Business Mailing Address
First Line	:	300 W 23RD ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-2547
Country	:	US
Telephone Number	:	402-721-1190
Fax Number	:	402-721-1199

Provider Business Practice Location Address
First Line	:	300 W 23RD ST
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-2547
Country	:	US
Telephone Number	:	402-721-1190
Fax Number	:	402-721-1199

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. RAY M BEACH
Credential	:	PC
Telephone Number	:	402-721-1190

Provider Enumeration Date	:	04/22/2010
Last Update Date	:	05/27/2010

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