Healthcare Provider Details

I. General information

NPI: 1578498663
Provider Name (Legal Business Name): BETHANY WOLCOTT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 KENMORE AVE
KENMORE NY
14217-2924
US

IV. Provider business mailing address

989 KENMORE AVE
KENMORE NY
14217-2924
US

V. Phone/Fax

Practice location:
  • Phone: 716-335-9711
  • Fax: 716-335-9696
Mailing address:
  • Phone: 716-335-9711
  • Fax: 716-335-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: