Provider Demographics
NPI:1679248892
Name:HAAS NIEHAUS, BETHANY KATHLEEN (DC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:KATHLEEN
Last Name:HAAS NIEHAUS
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 1:12636 LAMPLIGHTER SQUARE SHPG CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2746
Mailing Address - Country:US
Mailing Address - Phone:314-330-5773
Mailing Address - Fax:
Practice Address - Street 1:12636 LAMPLIGHTER SQUARE SHPG CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2746
Practice Address - Country:US
Practice Address - Phone:314-330-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor