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General NPI Number Information
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NPI Number | 1316960743
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Entity Type | Individual
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Provider Name | BETTY JEAN DESJARLAIS D.C.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 118 W BROADWAY
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City | MAYFIELD
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State | KY
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Zip | 42066-2214
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Country | US
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Telephone | 270-247-2121
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Fax | 270-247-2127
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Provider Business Mailing Address
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Address Line | 118 WEST BDWY
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City | MAYFIELD
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State | KY
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Zip | 42066-2314
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Country | US
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Telephone | 270-247-2121
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Fax | 270-247-2127
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5214
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License Number State | KY
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