Provider Demographics
NPI:1215099361
Name:BEATY, BRENDA LOUISE (DC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:BEATY
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 1:14044 S ALCAN ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6064
Mailing Address - Country:US
Mailing Address - Phone:913-634-7084
Mailing Address - Fax:
Practice Address - Street 1:2110 E SANTA FE ST
Practice Address - Street 2:FULK CHIROPRACTIC, PA
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1607
Practice Address - Country:US
Practice Address - Phone:913-764-6237
Practice Address - Fax:913-397-8230
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06112Medicare UPIN
G592452Medicare ID - Type Unspecified