Provider Demographics
NPI:1215116843
Name:VANROOY, BETHANY LEE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEE
Last Name:VANROOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:LEE
Other - Last Name:VAN ROOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:867 E HIGH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2156
Mailing Address - Country:US
Mailing Address - Phone:859-268-7501
Mailing Address - Fax:859-268-7502
Practice Address - Street 1:867 E HIGH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2156
Practice Address - Country:US
Practice Address - Phone:859-268-7501
Practice Address - Fax:859-268-7502
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor