MEDICARE: DR. JAMES WILLIAM BEAUCHAMP D.C.

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	S01678	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K4510001	OTHER	DC	BCBS FOR WASH DC
2	763B	OTHER		MARYLAND BCBS
3	K4510001	OTHER		BCBS FEDERAL
4	1141701	OTHER		ANOTHER AETNA #
5	325540	OTHER		PHCS INS. #
6	672779	OTHER		ACN PROVIDER NUMBER
7	S01678	OTHER	MD	CHIROPRACTIC LICENSE
8	10434460	OTHER		CAQH ID NUMBER
9	7365788	OTHER		AETNA OTHER #'S
10	1551638	OTHER		FIRST HEALTH INS
11	1323843	OTHER		AETNA

General Provider Information

NPI Number	:	1710057401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WILLIAM BEAUCHAMP D.C.

Provider Business Mailing Address
First Line	:	9601 PULASKI PARK DR
Second Line	:	SUITE 416
City	:	BALTIMORE
State	:	MD
Zip	:	21220-1409
Country	:	US
Telephone Number	:	410-933-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	3261 OLD WASHINGTON RD
Second Line	:	SUITE 2011
City	:	WALDORF
State	:	MD
Zip	:	20602-3223
Country	:	US
Telephone Number	:	301-396-9305
Fax Number	:	301-396-9309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/02/2015

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