MEDICARE: BETHANY JEAN KOLARIK D.C

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	2301006972	MI

General Provider Information

NPI Number	:	1124174370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY JEAN KOLARIK D.C

Provider Business Mailing Address
First Line	:	1203 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2938
Country	:	US
Telephone Number	:	231-935-4849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2938
Country	:	US
Telephone Number	:	231-935-4849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/08/2007

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