Provider Demographics
NPI:1871947770
Name:BEATTY, ZACH (DC)
Entity type:Individual
Prefix:DR
First Name:ZACH
Middle Name:
Last Name:BEATTY
Suffix:
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 1:7822 CONVOY CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1210
Mailing Address - Country:US
Mailing Address - Phone:858-997-8203
Mailing Address - Fax:
Practice Address - Street 1:7822 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1210
Practice Address - Country:US
Practice Address - Phone:858-997-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor