Provider Demographics
NPI:1376011916
Name:AKLILU, BETEL (DC)
Entity Type:Individual
Prefix:
First Name:BETEL
Middle Name:
Last Name:AKLILU
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 1:105 ORONOCO ST STE 115&117
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2089
Mailing Address - Country:US
Mailing Address - Phone:703-518-7936
Mailing Address - Fax:703-988-7535
Practice Address - Street 1:105 ORONOCO ST STE 115&117
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2089
Practice Address - Country:US
Practice Address - Phone:703-518-7936
Practice Address - Fax:703-988-7535
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03988111N00000X
VA0104557504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor