Healthcare Provider Details

I. General information

NPI: 1740480698
Provider Name (Legal Business Name): DARK & KAIBEL, D.C.'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E. 6TH STREET SUITE B-1
BEAUMONT CA
92223-2217
US

IV. Provider business mailing address

851 E. 6TH STREET SUITE B-1
BEAUMONT CA
92223-2217
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1931
  • Fax: 951-845-0557
Mailing address:
  • Phone: 951-845-1931
  • Fax: 951-845-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11294
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT L. DARK
Title or Position: PARTNER
Credential: D.C.
Phone: 951-845-1931