Provider Demographics
NPI:1184159782
Name:CARILLI, BETHANY (DC)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:CARILLI
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:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0371
Mailing Address - Country:US
Mailing Address - Phone:434-315-5868
Mailing Address - Fax:434-315-5989
Practice Address - Street 1:800 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1112
Practice Address - Country:US
Practice Address - Phone:434-315-5868
Practice Address - Fax:434-315-5989
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor