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General NPI Number Information
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NPI Number | 1225510076
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Entity Type | Organization
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Legal Business Name | BETHANY CARILLI, D.C., INC
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 800 BUFFALO ST
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City | FARMVILLE
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State | VA
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Zip | 23901-1112
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Country | US
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Telephone | 434-315-5868
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Fax | 434-315-5989
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Provider Business Mailing Address
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Address Line | PO BOX 371
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City | FARMVILLE
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State | VA
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Zip | 23901-0371
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Country | US
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Telephone | 434-315-5868
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Fax | 434-315-5989
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BETHANY CARILLI
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Credential | DC
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Telephone | 330-692-8891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557411
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License Number State | VA
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