Provider Demographics
NPI:1194751057
Name:EASTWOOD, MARY BETH (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:EASTWOOD
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:PO BOX 8872
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-8872
Mailing Address - Country:US
Mailing Address - Phone:830-308-5559
Mailing Address - Fax:
Practice Address - Street 1:7407 W FM 2147
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-1000
Practice Address - Country:US
Practice Address - Phone:830-308-5559
Practice Address - Fax:830-308-4467
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100174Medicare PIN