Provider Demographics
NPI:1194596817
Name:BETTLEYON, COLIN RAY (DC)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:RAY
Last Name:BETTLEYON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BRIGHTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1060
Mailing Address - Country:US
Mailing Address - Phone:207-780-1070
Mailing Address - Fax:
Practice Address - Street 1:949 BRIGHTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1060
Practice Address - Country:US
Practice Address - Phone:207-780-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2974111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician