Organization Active NPI

Scottsbluff Family Chiropractic PC

  • Chiropractor
  • Scottsbluff, NE
National Provider Identifier
1821208810
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1309 Issued in NE
Legal business name
SCOTTSBLUFF FAMILY CHIROPRACTIC PC
Practice address
24 W 17TH St
Scottsbluff, NE 69361-3156
Phone
(308) 630-0551
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kristin Michelle Beamon, D.C.NPI 1184682080
Title
President
Phone
(308) 630-0551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1309 NE Primary

Addresses

Primary practice location

24 W 17TH St
Scottsbluff, NE 69361-3156

Mailing address

24 W 17TH St
Scottsbluff, NE 69361-3156
Phone (308) 630-0551

Other identifiers 1

IdentifierTypeStateIssuer
100249717-00MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111025000391 NE Part B Supplier - Clinic/Group Practice 9436322146 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsbluff, NE

National Provider Directory

National Provider Directory

Locations

24 W 17th St
Scottsbluff, NE 69361
Phone (308) 630-0551

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1821208810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 W 17TH ST",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693613156",
            "telephone_number": "308-630-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 W 17TH ST",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693613156",
            "telephone_number": "308-630-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSBLUFF FAMILY CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "BEAMON",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "308-630-0551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100249717-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsbluff, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.