Provider Demographics
NPI:1225510076
Name:BETHANY CARILLI, D.C., INC
Entity Type:Organization
Organization Name:BETHANY CARILLI, D.C., INC
Other - Org Name:COMMUNITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARILLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-692-8891
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0371
Mailing Address - Country:US
Mailing Address - Phone:434-315-5868
Mailing Address - Fax:434-315-5989
Practice Address - Street 1:800 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1112
Practice Address - Country:US
Practice Address - Phone:434-315-5868
Practice Address - Fax:434-315-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty