Provider Demographics
NPI:1174876015
Name:BEACON OF HEALTH FAMILY CHIROPRACTIC AND NATURAL MEDICINE CENTER, INC.
Entity type:Organization
Organization Name:BEACON OF HEALTH FAMILY CHIROPRACTIC AND NATURAL MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE RUSCH
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-854-8005
Mailing Address - Street 1:1956 MESQUITE AVE
Mailing Address - Street 2:#103
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5888
Mailing Address - Country:US
Mailing Address - Phone:928-854-8005
Mailing Address - Fax:928-854-8006
Practice Address - Street 1:1956 MESQUITE AVE
Practice Address - Street 2:#103
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5888
Practice Address - Country:US
Practice Address - Phone:928-854-8005
Practice Address - Fax:928-854-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8291261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center