Provider Demographics
NPI:1316021256
Name:BEAVER, CHRISTOPHER SCOTT (DC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:BEAVER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 RIVERSTONE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5634
Mailing Address - Country:US
Mailing Address - Phone:770-479-5511
Mailing Address - Fax:770-479-1787
Practice Address - Street 1:1353 RIVERSTONE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5634
Practice Address - Country:US
Practice Address - Phone:770-479-5511
Practice Address - Fax:770-479-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA5033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA176560Medicare ID - Type Unspecified