Organization
PORTER COUNTY CHIROPRACTIC CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE L BEAUVAIS DC (OWNER)
(219) 465-5015
Entity
Organization
Contact information
Practice address
2600 ROOSEVELT RD, VALPARAISO, IN 46383-0970
(219) 465-5015
(219) 548-3828
Mailing address
PO BOX 1009, VALPARAISO, IN 46384-1009
(219) 465-5015
(219) 548-3828
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001767A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000105239
ANTHEM GROUP NUMBER
IN
05
—
200208460A
—
IN
01
—
350049047
RR MEDICARE GROUP NO
IN
01
—
90000986
IL BC/BS GROUP NUMBER
IL
Enumeration date
11/23/2005
Last updated
06/29/2015
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