Provider Demographics
NPI:1306648845
Name:BELTRAN, JOSE III
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BELTRAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W AVENUE Q STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3887
Mailing Address - Country:US
Mailing Address - Phone:661-947-2455
Mailing Address - Fax:
Practice Address - Street 1:615 W AVENUE Q STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3887
Practice Address - Country:US
Practice Address - Phone:661-947-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37253OtherBOARD OF CHIROPRACTIC EXAMINERS