Provider Demographics
NPI:1497804983
Name:BETANCUR, RICK (DC)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:BETANCUR
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 1:1945 MORRIS AVE STE 9
Mailing Address - Street 2:ADVANCED SPINE CENTER
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3518
Mailing Address - Country:US
Mailing Address - Phone:973-567-7463
Mailing Address - Fax:908-688-0004
Practice Address - Street 1:1945 MORRIS AVE STE 9
Practice Address - Street 2:ADVANCED SPINE CENTER
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3518
Practice Address - Country:US
Practice Address - Phone:973-567-7463
Practice Address - Fax:908-688-0004
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2358111N00000X
NJ38MC00706600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y36695OtherBC
Y45368Medicare ID - Type Unspecified