Healthcare Provider Details

I. General information

NPI: 1033283163
Provider Name (Legal Business Name): JONATHAN BELTRAMINI D C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13636 N TATUM BLVD SUITE 15
PHOENIX AZ
85032-6400
US

IV. Provider business mailing address

13636 N TATUM BLVD SUITE 15
PHOENIX AZ
85032-6400
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-8735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: