Provider Demographics
NPI:1770824559
Name:DILL, KILEY BETH
Entity Type:Individual
Prefix:DR
First Name:KILEY
Middle Name:BETH
Last Name:DILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6297 STATE ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-8209
Mailing Address - Country:US
Mailing Address - Phone:440-839-1055
Mailing Address - Fax:
Practice Address - Street 1:6297 STATE ROUTE 303
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-8209
Practice Address - Country:US
Practice Address - Phone:440-839-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor