Provider Demographics
NPI:1215042171
Name:ERWIN, BEAUFORD TALIAFERRO III (DC)
Entity type:Individual
Prefix:DR
First Name:BEAUFORD
Middle Name:TALIAFERRO
Last Name:ERWIN
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TOBY
Other - Middle Name:
Other - Last Name:ERWIN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3930 W VICKERY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5626
Mailing Address - Country:US
Mailing Address - Phone:817-732-3344
Mailing Address - Fax:817-732-3353
Practice Address - Street 1:3930 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5626
Practice Address - Country:US
Practice Address - Phone:817-732-3344
Practice Address - Fax:817-732-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1262OtherBCBS
TX9274660OtherPHCS