MEDICARE: BETTIOL FAMILY ENTERPRISES, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9875	TX

General Provider Information

NPI Number	:	1316128838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTIOL FAMILY ENTERPRISES, LP

Provider Business Mailing Address
First Line	:	2151 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 112
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5281
Country	:	US
Telephone Number	:	979-764-3100
Fax Number	:	979-764-3144

Provider Business Practice Location Address
First Line	:	2151 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 112
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5281
Country	:	US
Telephone Number	:	979-764-3100
Fax Number	:	979-764-3144

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SHEILA S BETTIOL
Credential	:
Telephone Number	:	979-764-3100

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/21/2011

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