MEDICARE: DR. DANIEL A BETTIOL 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	9875	TX

General Provider Information

NPI Number	:	1700898756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A BETTIOL D.C

Provider Business Mailing Address
First Line	:	2151 HARVEY MITCHELL PKWY
Second Line	:	SUITE 112
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840
Country	:	US
Telephone Number	:	979-764-3100
Fax Number	:	979-764-3144

Provider Business Practice Location Address
First Line	:	2151 HARVEY MITCHELL PKWY S
Second Line	:	SUITE 112
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5281
Country	:	US
Telephone Number	:	979-764-3100
Fax Number	:	979-764-3144

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/27/2007

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