Provider Demographics
NPI:1912006610
Name:COGGINS, BEAU JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:JEFFREY
Last Name:COGGINS
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 1:906 E AVENUE B
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-3812
Mailing Address - Country:US
Mailing Address - Phone:432-837-5070
Mailing Address - Fax:432-837-3203
Practice Address - Street 1:906 E AVENUE B
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-3812
Practice Address - Country:US
Practice Address - Phone:432-837-5070
Practice Address - Fax:432-837-3203
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611683Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXV04557Medicare UPIN