Provider Demographics
NPI:1720215189
Name:BEUTLER-ENGLAND CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BEUTLER-ENGLAND CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOROCIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-9313
Mailing Address - Street 1:1200 ENTERPRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6322
Mailing Address - Country:US
Mailing Address - Phone:337-439-9313
Mailing Address - Fax:337-439-8045
Practice Address - Street 1:1200 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6322
Practice Address - Country:US
Practice Address - Phone:337-439-9313
Practice Address - Fax:337-439-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19990Medicare UPIN