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General NPI Number Information
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NPI Number | 1144203183
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Entity Type | Organization
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Legal Business Name | PORTER COUNTY CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 2600 ROOSEVELT RD
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City | VALPARAISO
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State | IN
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Zip | 46383-0970
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Country | US
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Telephone | 219-465-5015
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Fax | 219-548-3828
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Provider Business Mailing Address
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Address Line | PO BOX 1009
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City | VALPARAISO
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State | IN
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Zip | 46384-1009
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Country | US
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Telephone | 219-465-5015
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Fax | 219-548-3828
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE L BEAUVAIS
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Credential | DC
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Telephone | 219-465-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08001767A
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License Number State | IN
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