Provider Demographics
NPI:1720236698
Name:VALLAR, BETHANY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANN
Last Name:VALLAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ODOVERO DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3010
Mailing Address - Country:US
Mailing Address - Phone:906-228-2600
Mailing Address - Fax:906-228-3878
Practice Address - Street 1:1301 ODOVERO DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5505
Practice Address - Country:US
Practice Address - Phone:906-228-2600
Practice Address - Fax:906-228-3878
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM74030007Medicare PIN