Provider Demographics
NPI:1023019213
Name:BEATY, MARK ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BEATY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S TWIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4341
Mailing Address - Country:US
Mailing Address - Phone:409-727-0010
Mailing Address - Fax:409-727-4858
Practice Address - Street 1:910 S TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4341
Practice Address - Country:US
Practice Address - Phone:409-727-0010
Practice Address - Fax:409-727-4858
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUO6012Medicare UPIN
TX603288ZSH0Medicare PIN
TX603288Medicare ID - Type Unspecified