Provider Demographics
NPI:1508093774
Name:BOTTESCH, HANS WERNER II (DC)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:WERNER
Last Name:BOTTESCH
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1752
Mailing Address - Country:US
Mailing Address - Phone:570-204-9302
Mailing Address - Fax:570-317-2594
Practice Address - Street 1:214 CENTER ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1752
Practice Address - Country:US
Practice Address - Phone:570-204-9302
Practice Address - Fax:570-317-2594
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010201111N00000X
PAAJ010007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177706Medicare PIN