Individual
DR. DALE LEE BEAUVAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
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
—
000000093417
ANTHEM PROVIDER NUMBER
IN
05
—
200155470C
—
IN
01
—
350049047
RR MEDICARE GROUP NO
IN
01
—
90000986
IL BC/BS GROUP NO
IL
Enumeration date
03/19/2007
Last updated
06/29/2015
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