Provider Demographics
NPI:1760575690
Name:BEATY, JOHN RANDALL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDALL
Last Name:BEATY
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 1:2089A COUNTY ROAD 700
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7359
Mailing Address - Country:US
Mailing Address - Phone:662-286-0251
Mailing Address - Fax:
Practice Address - Street 1:2668 S HARPER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6770
Practice Address - Country:US
Practice Address - Phone:662-287-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor