Provider Demographics
NPI:1790764629
Name:BELTZ, JOHN R (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:BELTZ
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 1:821 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2705
Mailing Address - Country:US
Mailing Address - Phone:330-296-9030
Mailing Address - Fax:330-296-8003
Practice Address - Street 1:821 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2705
Practice Address - Country:US
Practice Address - Phone:330-296-9030
Practice Address - Fax:330-296-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891012Medicaid
U35041Medicare UPIN
OHBE0725281Medicare ID - Type Unspecified