Provider Demographics
NPI:1134140601
Name:WINTHER GALIMORE, BETHANY ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANNE
Last Name:WINTHER GALIMORE
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 1:501 CASS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9677
Mailing Address - Country:US
Mailing Address - Phone:573-286-2528
Mailing Address - Fax:
Practice Address - Street 1:1720 S WALTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7533
Practice Address - Country:US
Practice Address - Phone:479-464-0834
Practice Address - Fax:479-464-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009842111N00000X
AR16243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO194446OtherBLUE CROSS/BLUE SHIELD
MO000014594Medicare ID - Type Unspecified
MOV03759Medicare UPIN