Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5637 | AZ |
NPI | 1033283163 |
---|---|
Provider Name | Dr. Jonathan Beltramini |
First Address | Phoenix, AZ 85032-6400 |
Second Address | Phoenix, AZ 85032-6400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U64250 | (02) | AZ |