MEDICARE: JOHN BEEDLE DC

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	111NS0005X	Sports Physician Chiropractor	B01850	NV
2	111N00000X	Chiropractor	B01850	NV
3	111NN1001X	Nutrition Chiropractor	B01850	NV
4	111NR0400X	Rehabilitation Chiropractor	B01850	NV

General Provider Information

NPI Number	:	1922614007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BEEDLE DC

Provider Business Mailing Address
First Line	:	9525 HILLWOOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0596
Country	:	US
Telephone Number	:	702-642-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 HILLWOOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0596
Country	:	US
Telephone Number	:	702-642-5446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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Directions to “ JOHN BEEDLE DC” Practice Location

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