Healthcare Provider Details

I. General information

NPI: 1801873799
Provider Name (Legal Business Name): HERBERT M BEATTY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 PENNSYLVANIA CIR NE
ALBUQUERQUE NM
87110-7824
US

IV. Provider business mailing address

8004 PENNSYLVANIA CIR NE
ALBUQUERQUE NM
87110-7824
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-2465
  • Fax: 505-268-0820
Mailing address:
  • Phone: 505-268-2465
  • Fax: 505-268-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number384
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: