Provider Demographics
NPI:1316960743
Name:DESJARLAIS, BETTY JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JEAN
Last Name:DESJARLAIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WEST BDWY
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2314
Mailing Address - Country:US
Mailing Address - Phone:270-247-2121
Mailing Address - Fax:270-247-2127
Practice Address - Street 1:118 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2214
Practice Address - Country:US
Practice Address - Phone:270-247-2121
Practice Address - Fax:270-247-2127
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400033001Medicare PIN