Provider Demographics
NPI:1093834368
Name:PRILLWITZ, BETH A (DC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:PRILLWITZ
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 1:712 COMINGS AVE
Mailing Address - Street 2:P.O. BOX 52
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1943
Mailing Address - Country:US
Mailing Address - Phone:269-983-8989
Mailing Address - Fax:269-983-1875
Practice Address - Street 1:712 COMINGS AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1943
Practice Address - Country:US
Practice Address - Phone:269-983-8989
Practice Address - Fax:269-983-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A15012OtherBLUE CROSS BLUE SHIELD
MI141903516Medicaid
MI950A15012OtherBLUE CROSS BLUE SHIELD
MIT32617Medicare UPIN