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NPI Code Detail

MEDICARE: TYRA L BEAVERS BS PTA DC

MEDICARE: TYRA L BEAVERS BS PTA DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC23792CA

General Provider Information

NPI Number : 1649450735
Entity Type Code : Organization
Provider Name (Legal Business Name) : TYRA L BEAVERS BS PTA DC
Provider Business Mailing Address
First Line : 250 N ROBERTSON BLVD STE 411
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-1793
Country : US
Telephone Number : 310-859-7696
Fax Number : 310-859-7699
Provider Business Practice Location Address
First Line : 250 N ROBERTSON BLVD STE 411
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-1793
Country : US
Telephone Number : 310-859-7696
Fax Number : 310-859-7699
Authorized Official
Title or Position : OWNER/CHIROPRACTOR
Name : MRS. TYRA LYNN BEAVERS
Credential : D.C.
Telephone Number : 310-859-7696
Provider Enumeration Date : 11/06/2007
Last Update Date : 04/10/2019

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