Provider Demographics
NPI:1417292012
Name:BARETICH, BETHANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHANNE
Middle Name:
Last Name:BARETICH
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 1:15951 LOS GATOS BLVD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3428
Mailing Address - Country:US
Mailing Address - Phone:408-358-5086
Mailing Address - Fax:408-358-5099
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:SUITE # 3
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3428
Practice Address - Country:US
Practice Address - Phone:408-538-5086
Practice Address - Fax:408-358-5099
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor