Provider Demographics
NPI:1972677268
Name:BETTS, PAUL DWIGHT JR (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DWIGHT
Last Name:BETTS
Suffix:JR
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 1:2100 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4332
Mailing Address - Country:US
Mailing Address - Phone:870-897-3722
Mailing Address - Fax:870-802-0352
Practice Address - Street 1:2705 PAULA DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8017
Practice Address - Country:US
Practice Address - Phone:870-713-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7119090OtherAETNA
AR5U532OtherAR BCBS
AR54532OtherBLUE CROSS BLUE SHIELD
U77849Medicare UPIN