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NPI Code Detail

MEDICARE: MS. SHERRY RENAY BETHEA D.C.

MEDICARE: MS. SHERRY RENAY BETHEA 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
1111N00000XChiropractor3727SC

General Provider Information

NPI Number : 1619234614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHERRY RENAY BETHEA D.C.
Provider Business Mailing Address
First Line : 1272 WOODRUFF RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-5754
Country : US
Telephone Number : 864-303-6121
Fax Number :
Provider Business Practice Location Address
First Line : 1272 WOODRUFF RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-5754
Country : US
Telephone Number : 864-303-6121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2012
Last Update Date : 04/13/2012

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