Provider Demographics
NPI:1184644585
Name:BEDDOE, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:BEDDOE
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:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1787
Mailing Address - Country:US
Mailing Address - Phone:310-454-0648
Mailing Address - Fax:310-469-5229
Practice Address - Street 1:15150 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3720
Practice Address - Country:US
Practice Address - Phone:310-454-0648
Practice Address - Fax:310-469-5229
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC12125AMedicare PIN