Healthcare Provider Details

I. General information

NPI: 1396713582
Provider Name (Legal Business Name): BETH ANNE WEST D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 N WALNUT ST
CAMERON MO
64429-8615
US

IV. Provider business mailing address

1809 N WALNUT ST
CAMERON MO
64429-8615
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-6201
  • Fax: 816-632-6210
Mailing address:
  • Phone: 816-632-6201
  • Fax: 816-632-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2002028184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: