Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 2415 | AL |
Y | 111NS0005X | Chiropractic Sports Physician | 2415 | AL |
NPI | 1154753739 |
---|---|
Provider Name | Dr. Beau Ryan Beard |
First Address | Birmingham, AL 35242-1405 |
Second Address | Birmingham, AL 35242-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 09/01/2014 |