Provider Demographics
NPI:1770624827
Name:BEAVERS, DAVID V (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
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 1:11104 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1113
Mailing Address - Country:US
Mailing Address - Phone:636-625-6000
Mailing Address - Fax:636-625-6000
Practice Address - Street 1:11104 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1113
Practice Address - Country:US
Practice Address - Phone:636-625-6000
Practice Address - Fax:636-625-6008
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3306OtherBLUE SHIELD
MOU09995Medicare UPIN
MO3306OtherBLUE SHIELD