Provider Demographics
NPI:1659355006
Name:BETTS, BRIAN DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DEAN
Last Name:BETTS
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 1:10607 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3539
Mailing Address - Country:US
Mailing Address - Phone:952-881-5703
Mailing Address - Fax:952-881-6871
Practice Address - Street 1:10607 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3539
Practice Address - Country:US
Practice Address - Phone:952-881-5703
Practice Address - Fax:952-881-6871
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN847728100Medicaid
MN227L0BEOtherBCBS EAGAN
MN227L1BEOtherBCBS LAKEVILLE
MN847728100Medicaid
MN350001834Medicare PIN