=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548486111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROCARE HEALTH CENTER, BELTRAN CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 06/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 S VERDUGO RD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-459-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 S VERDUGO RD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-459-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AGATHA MAE BELTRAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 818-459-0569
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC29613
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------