Provider Demographics
NPI:1285701599
Name:BEUTZ, HOLLY A (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:A
Last Name:BEUTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:DOHRN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1170 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3770
Mailing Address - Country:US
Mailing Address - Phone:503-656-9877
Mailing Address - Fax:503-657-1225
Practice Address - Street 1:1170 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3770
Practice Address - Country:US
Practice Address - Phone:503-656-9877
Practice Address - Fax:503-657-1225
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137191OtherGROUP PIN
ORV12048Medicare UPIN
OR137191OtherGROUP PIN