Tyra L Beavers

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC23792 Issued in CA

Practice address

250 N Robertson Blvd
Suite 516
Beverly Hills, CA 90211-1788

Phone

(310) 859-7696

Fax

(310) 859-7699

NPI assigned

Apr 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Tyra Douglas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1336106889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N ROBERTSON BLVD STE 411",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111793",
            "telephone_number": "310-859-7696",
            "fax_number": "310-859-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N ROBERTSON BLVD",
            "address_2": "SUITE 516",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111788",
            "telephone_number": "310-859-7696",
            "fax_number": "310-859-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVERS",
        "first_name": "TYRA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "23792",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC23792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "DC23792",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INS TAX ID",
            "identifier": "200355585",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TYRA",
            "last_name": "DOUGLAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Be Well Berlin a Professional Nursing Corporation (Be Well Medical Group)
• Be Well Medical Group a Medical Corporation
• Be Well Professional Services LLC
• Beacon Surgical Center, LLC.
• Alex Beaudreault
• Bech Medical, Inc., a Professional Corporation
• Zanne Bech, MS
• Rani Bechar
• Joel L. Becker, PHD
• Beckett, MD, Inc.

• Chiropractor in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.