Provider Demographics
NPI:1184658023
Name:BLAKELY, BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MORPHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3928 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2743
Mailing Address - Country:US
Mailing Address - Phone:916-944-1444
Mailing Address - Fax:916-944-8458
Practice Address - Street 1:3928 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2743
Practice Address - Country:US
Practice Address - Phone:916-944-1444
Practice Address - Fax:916-944-8458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0183340Medicare ID - Type Unspecified