MEDICARE: BEATTY HEALTH AND WELLNESS LLC

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1275140808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEATTY HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	6601 VETERANS MEMORIAL BLVD STE 33
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-3943
Country	:	US
Telephone Number	:	504-455-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 VETERANS MEMORIAL BLVD STE 33
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70003-3943
Country	:	US
Telephone Number	:	504-455-2242
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EVAN TYLER BEATTY
Credential	:
Telephone Number	:	504-455-2242

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	10/11/2020

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