Provider Demographics
NPI:1972982395
Name:BEAVERS, ZACH (LAC)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N COLLEGE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5311
Mailing Address - Country:US
Mailing Address - Phone:479-871-6088
Mailing Address - Fax:
Practice Address - Street 1:130 N COLLEGE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5311
Practice Address - Country:US
Practice Address - Phone:479-871-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL.AC.067171100000X
TXAC01372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist