Provider Demographics
NPI:1497872618
Name:DR. BEATRICE B. KILGUSS DC
Entity Type:Organization
Organization Name:DR. BEATRICE B. KILGUSS DC
Other - Org Name:DESOTO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:BABULA
Authorized Official - Last Name:KILGUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-223-2433
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD876 SOLO #OtherBCBS SOLO #
TXP00064426OtherMEDICARE RAILROAD
TX0007PU GROUP#OtherBCBS GROUP#
TX604061Medicare ID - Type UnspecifiedMEDICARE
TNU47889Medicare UPIN