Provider Demographics
NPI:1043230063
Name:BETANCOURT, MIGUEL (CHIROPRACTOR PA)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:CHIROPRACTOR PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8740 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3201
Mailing Address - Country:US
Mailing Address - Phone:305-228-2772
Mailing Address - Fax:305-228-2928
Practice Address - Street 1:8740 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3201
Practice Address - Country:US
Practice Address - Phone:305-228-2772
Practice Address - Fax:305-228-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCI 469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI 469OtherCERTIFIED CHIROPRACTOR P.