=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801580949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BODYWORKS BY BETH: CHIROPRACTIC AND MASSAGE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2023
-----------------------------------------------------
Last Update Date | 06/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 EMBARCADERO DR STE A
-----------------------------------------------------
City | EL DORADO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95762-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-680-9775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 496 MAIN ST
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-680-9775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYER
-----------------------------------------------------
Name | BETH ANDERSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 949-680-9775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------