Provider Demographics
NPI:1326021395
Name:BATESON, C. OWEN (DC)
Entity type:Individual
Prefix:
First Name:C.
Middle Name:OWEN
Last Name:BATESON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 S GAY ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4311
Mailing Address - Country:US
Mailing Address - Phone:530-257-5543
Mailing Address - Fax:530-257-3345
Practice Address - Street 1:63 S GAY ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4311
Practice Address - Country:US
Practice Address - Phone:530-257-5543
Practice Address - Fax:530-257-3345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10296111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0102960Medicare ID - Type Unspecified
CAT03885Medicare UPIN