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General NPI Number Information
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NPI Number | 1811014921
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Entity Type | Organization
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Legal Business Name | BRUCE BEDDOE DC A CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 860 VIA DE LA PAZ STE F6
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3643
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Country | US
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Telephone | 310-454-0648
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Fax | 310-469-5229
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Provider Business Mailing Address
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Address Line | PO BOX 1787
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-1787
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Country | US
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Telephone | 310-454-0648
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Fax | 310-469-5229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE BEDDOE
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Credential | D.C.
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Telephone | 310-454-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12125
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License Number State | CA
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