Provider Demographics
NPI:1043275464
Name:BECHARD CHIROPRACTIC INC
Entity type:Organization
Organization Name:BECHARD CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BECHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-421-8588
Mailing Address - Street 1:11225 COMMERCE DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3122
Mailing Address - Country:US
Mailing Address - Phone:763-421-8588
Mailing Address - Fax:763-422-4183
Practice Address - Street 1:11225 COMMERCE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3122
Practice Address - Country:US
Practice Address - Phone:763-421-8588
Practice Address - Fax:763-422-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN090828200Medicaid
MN090828200Medicaid