Provider Demographics
NPI:1497394456
Name:BELTRAN, JOSHUA BRAVO (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRAVO
Last Name:BELTRAN
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 1:432 W LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-5004
Mailing Address - Country:US
Mailing Address - Phone:724-349-2462
Mailing Address - Fax:
Practice Address - Street 1:210 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7701
Practice Address - Country:US
Practice Address - Phone:714-398-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34652111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation