Provider Demographics
NPI:1760492482
Name:BETHEA, DAREN Z II (DC)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:Z
Last Name:BETHEA
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 1:2122 N SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7453
Mailing Address - Country:US
Mailing Address - Phone:704-295-1641
Mailing Address - Fax:704-295-1498
Practice Address - Street 1:2122 N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7453
Practice Address - Country:US
Practice Address - Phone:704-295-1641
Practice Address - Fax:704-295-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3037111N00000X
NC3802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor