Provider Demographics
NPI:1811033400
Name:BETHUNE, ERIKA NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:NICOLE
Last Name:BETHUNE
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 1:6406 E FOWLER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2400
Mailing Address - Country:US
Mailing Address - Phone:813-985-9191
Mailing Address - Fax:813-980-2354
Practice Address - Street 1:6406 E FOWLER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2400
Practice Address - Country:US
Practice Address - Phone:813-985-9191
Practice Address - Fax:813-980-2354
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4501XMedicare ID - Type Unspecified