Provider Demographics
NPI:1740505478
Name:O'ROURKE, BETH MICHELLE (DC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MICHELLE
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E CARSON PLAZA DR
Mailing Address - Street 2:STE 122
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3229
Mailing Address - Country:US
Mailing Address - Phone:310-324-6172
Mailing Address - Fax:
Practice Address - Street 1:550 E CARSON PLAZA DR
Practice Address - Street 2:STE 122
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3229
Practice Address - Country:US
Practice Address - Phone:310-324-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor