Provider Demographics
NPI:1831399393
Name:BATEY, BREANNA RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:RENEE
Last Name:BATEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BREANNA
Other - Middle Name:RENEE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2901 E ZION RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5070
Mailing Address - Country:US
Mailing Address - Phone:479-879-9990
Mailing Address - Fax:
Practice Address - Street 1:2901 E ZION RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5070
Practice Address - Country:US
Practice Address - Phone:479-879-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
AR16192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200288400AMedicaid