Provider Demographics
NPI:1326503491
Name:DRUCKENMILLER, BETHANY (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:DRUCKENMILLER
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 1:625 PONDER PLACE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3342
Mailing Address - Country:US
Mailing Address - Phone:706-524-8077
Mailing Address - Fax:
Practice Address - Street 1:625 PONDER PLACE DR STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3342
Practice Address - Country:US
Practice Address - Phone:706-524-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor