Provider Demographics
NPI:1003898511
Name:BETOUSHANA, DEMEIL (DC)
Entity Type:Individual
Prefix:DR
First Name:DEMEIL
Middle Name:
Last Name:BETOUSHANA
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 1:800 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-2614
Mailing Address - Country:US
Mailing Address - Phone:209-667-7333
Mailing Address - Fax:209-667-7755
Practice Address - Street 1:800 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-2614
Practice Address - Country:US
Practice Address - Phone:209-667-7333
Practice Address - Fax:209-667-7755
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0266800Medicare ID - Type Unspecified
CAU79664Medicare UPIN