Provider Demographics
NPI:1386636124
Name:KILGUSS, BEATRICE BABULA (DC)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:BABULA
Last Name:KILGUSS
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 1:101 S LYNDALYN AVE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5709
Mailing Address - Country:US
Mailing Address - Phone:972-223-2433
Mailing Address - Fax:972-223-7290
Practice Address - Street 1:101 S LYNDALYN AVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5709
Practice Address - Country:US
Practice Address - Phone:972-223-2433
Practice Address - Fax:972-223-7290
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX6376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00064426OtherMEDICARE RAILROAD NUMBER
TX0007PU GROUPOtherBCBS GROUP ID #
TX8AD876 SOLO#OtherBCBS SOLO#
TX604061Medicare PIN
TXU47889Medicare UPIN
TX604061Medicare ID - Type UnspecifiedMEDICARE