Provider Demographics
NPI:1720208127
Name:CIUCHTA, BETTY J (DC)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:J
Last Name:CIUCHTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2847
Mailing Address - Country:US
Mailing Address - Phone:562-434-7260
Mailing Address - Fax:562-433-5058
Practice Address - Street 1:4101 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2847
Practice Address - Country:US
Practice Address - Phone:562-434-7260
Practice Address - Fax:562-433-5058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17820Medicare ID - Type Unspecified