Provider Demographics
NPI:1013145564
Name:PRIME WELLNESS CARE, BELTRAN CHIROPRACTIC INC
Entity type:Organization
Organization Name:PRIME WELLNESS CARE, BELTRAN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-5500
Mailing Address - Street 1:14624 SHERMAN WAY STE 307
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2288
Mailing Address - Country:US
Mailing Address - Phone:818-785-5500
Mailing Address - Fax:818-758-5528
Practice Address - Street 1:14624 SHERMAN WAY STE 307
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2288
Practice Address - Country:US
Practice Address - Phone:818-785-5500
Practice Address - Fax:818-758-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty