Healthcare Provider Details

I. General information

NPI: 1629168471
Provider Name (Legal Business Name): JILL W. BETZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 ATLANTIC HWY.
LINCOLNVILLE ME
04849
US

IV. Provider business mailing address

PO BOX 47
LINCOLNVILLE ME
04849-0047
US

V. Phone/Fax

Practice location:
  • Phone: 207-236-6272
  • Fax: 207-236-6252
Mailing address:
  • Phone: 207-236-6272
  • Fax: 207-236-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR1322
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: