Provider Demographics
NPI:1639370117
Name:BEAUMONT CHIROPRACTIC
Entity Type:Organization
Organization Name:BEAUMONT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-845-1177
Mailing Address - Street 1:890 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5937
Mailing Address - Country:US
Mailing Address - Phone:951-845-1177
Mailing Address - Fax:951-845-5543
Practice Address - Street 1:890 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5937
Practice Address - Country:US
Practice Address - Phone:951-845-1177
Practice Address - Fax:951-845-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0084170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA156853786OtherNPI
CA8417Medicare UPIN
CADC0084170Medicare ID - Type Unspecified