Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 412 | LA |
NPI | 1003917642 |
---|---|
Provider Name | Ms. Carol Margaret Beutler |
First Address | Lake Charles, LA 70601 |
Second Address | Lake Charles, LA 70601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1952940 | (05) | LA |
T19990 | (02) |