Provider Demographics
NPI:1235451493
Name:BEATTY, ROBIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:R
Last Name:BEATTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:R
Other - Last Name:ROECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2205 N SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3310
Mailing Address - Country:US
Mailing Address - Phone:608-244-0044
Mailing Address - Fax:608-244-2773
Practice Address - Street 1:2205 N SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704
Practice Address - Country:US
Practice Address - Phone:608-244-0044
Practice Address - Fax:608-244-2773
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4597-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor