Provider Demographics
NPI:1750543021
Name:PACIFIC WEST WELLNESS CENTER BELTRAN CHIROPRACTIC INC
Entity type:Organization
Organization Name:PACIFIC WEST WELLNESS CENTER BELTRAN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-459-0569
Mailing Address - Street 1:203 S VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1424
Mailing Address - Country:US
Mailing Address - Phone:818-459-0569
Mailing Address - Fax:818-545-0793
Practice Address - Street 1:203 S VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1424
Practice Address - Country:US
Practice Address - Phone:818-459-0569
Practice Address - Fax:818-545-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty