Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC0170060 | CA |
NPI | 1114929619 |
---|---|
Provider Name | Dr. Jeffery G Beavers |
First Address | Carmichael, CA 95608-4471 |
Second Address | Carmichael, CA 95608-4471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T06327 | (02) | CA |