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Individual
TYRA L BEAVERS
Active
Individual
TYRA L BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
23792
CA
111N00000X
Chiropractor
Primary
DC23792
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200355585
PRIVATE INS TAX ID
CA
01
—
DC23792
PRIVATE INSURANCE
CA
Enumeration date
04/27/2006
Last updated
04/30/2019
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