Provider Demographics
NPI:1902952088
Name:BEAUDET, JACQUELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:BEAUDET
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W SAUTHOFF RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1146
Mailing Address - Country:US
Mailing Address - Phone:608-442-8016
Mailing Address - Fax:608-442-8018
Practice Address - Street 1:217 W SAUTHOFF RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1146
Practice Address - Country:US
Practice Address - Phone:608-442-8016
Practice Address - Fax:608-442-8018
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1720-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075615Medicare ID - Type Unspecified