Provider Demographics
NPI:1326364704
Name:GENOVEA, BETHONY GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHONY
Middle Name:GRACE
Last Name:GENOVEA
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 1:3862 SMITH ST
Mailing Address - Street 2:STE. B
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2614
Mailing Address - Country:US
Mailing Address - Phone:510-545-2551
Mailing Address - Fax:
Practice Address - Street 1:3862 SMITH ST
Practice Address - Street 2:STE. B
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2614
Practice Address - Country:US
Practice Address - Phone:510-545-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor