Healthcare Provider Details

I. General information

NPI: 1922614007
Provider Name (Legal Business Name): JOHN BEEDLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 HILLWOOD DR STE 100
LAS VEGAS NV
89134-0596
US

IV. Provider business mailing address

9525 HILLWOOD DR STE 100
LAS VEGAS NV
89134-0596
US

V. Phone/Fax

Practice location:
  • Phone: 702-642-5446
  • Fax:
Mailing address:
  • Phone: 702-642-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberB01850
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01850
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberB01850
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberB01850
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: