Provider Demographics
NPI:1023062015
Name:BEAUVAIS, DARRELL SCOTT (DC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:SCOTT
Last Name:BEAUVAIS
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 MORTHLAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6205
Mailing Address - Country:US
Mailing Address - Phone:219-615-3178
Mailing Address - Fax:219-615-3187
Practice Address - Street 1:265 MORTHLAND DR STE E
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6205
Practice Address - Country:US
Practice Address - Phone:219-615-3178
Practice Address - Fax:219-615-3187
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002084A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300084683Medicaid
INU91756Medicare UPIN
INU91756Medicare UPIN