1497872618 NPI number — DR. BEATRICE B. KILGUSS DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497872618 NPI number — DR. BEATRICE B. KILGUSS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. BEATRICE B. KILGUSS DC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DESOTO CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497872618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 S LYNDALYN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-5709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-223-2433
Provider Business Mailing Address Fax Number:
972-223-7290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S LYNDALYN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-223-2433
Provider Business Practice Location Address Fax Number:
972-223-7290
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KILGUSS
Authorized Official First Name:
BEATRICE
Authorized Official Middle Name:
BABULA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-223-2433

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6376 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8AD876 SOLO # . This is a "BCBS SOLO #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00064426 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0007PU GROUP# . This is a "BCBS GROUP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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