=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386636124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEATRICE BABULA KILGUSS D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2005
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S LYNDALYN AVE
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-2433
-----------------------------------------------------
Fax | 972-223-7290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 S LYNDALYN AVE
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-2433
-----------------------------------------------------
Fax | 972-223-7290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | TX6376
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------