Provider Demographics
NPI:1508131327
Name:BURYTA, BETHANY HEATHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:HEATHER
Last Name:BURYTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:HEATHER
Other - Last Name:DREILING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:620 PARK AVE STE 199
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2943
Mailing Address - Country:US
Mailing Address - Phone:585-252-2099
Mailing Address - Fax:
Practice Address - Street 1:PATIENT HOME VISIT
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2943
Practice Address - Country:US
Practice Address - Phone:585-252-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012113111N00000X
MI2301010221111N00000X
NYX013099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor