Provider Demographics
NPI:1699413013
Name:PAISER, BETHANY (DC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PAISER
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 1:1830 W MASON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2369
Mailing Address - Country:US
Mailing Address - Phone:920-393-8171
Mailing Address - Fax:
Practice Address - Street 1:1830 W MASON ST STE 5
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2369
Practice Address - Country:US
Practice Address - Phone:920-393-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor