Provider Demographics
NPI:1811014921
Name:BRUCE BEDDOE DC A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:BRUCE BEDDOE DC A CHIROPRACTIC CORPORATION
Other - Org Name:PALISADES HOLISTIC CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDDOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-454-0648
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1787
Mailing Address - Country:US
Mailing Address - Phone:310-454-0648
Mailing Address - Fax:310-469-5229
Practice Address - Street 1:860 VIA DE LA PAZ STE F6
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3643
Practice Address - Country:US
Practice Address - Phone:310-454-0648
Practice Address - Fax:310-469-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21060Medicare PIN