Organization
JASPER COUNTY CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRELL SCOTT BEAUVAIS D.C. (PRESIDENT)
(219) 987-3366
Entity
Organization
Contact information
Practice address
701 SOUTH HALLECK STREET, DEMOTTE, IN 46310
(219) 987-3366
(219) 987-3366
Mailing address
701 SOUTH HALLECK STREET, DEMOTTE, IN 46310
(219) 987-3366
(219) 987-3366
Taxonomy
Speciality
Code
Description
License number
State
111NR0200X
Radiology Chiropractor
Primary
08002084A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200444880A
—
IN
Enumeration date
12/14/2012
Last updated
12/14/2012
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