Provider Demographics
NPI:1720046550
Name:BEAVERS, DARREN WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:WAYNE
Last Name:BEAVERS
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 1:11330 ARCADE DR
Mailing Address - Street 2:STE 5
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4085
Mailing Address - Country:US
Mailing Address - Phone:501-224-1332
Mailing Address - Fax:
Practice Address - Street 1:11330 ARCADE DR
Practice Address - Street 2:STE 5
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4085
Practice Address - Country:US
Practice Address - Phone:501-224-1332
Practice Address - Fax:501-224-1964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU38597Medicare UPIN
AR59332Medicare ID - Type Unspecified