Provider Demographics
NPI:1700898756
Name:BETTIOL, DANIEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:BETTIOL
Suffix:
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 1:2151 HARVEY MITCHELL PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840
Mailing Address - Country:US
Mailing Address - Phone:979-764-3100
Mailing Address - Fax:979-764-3144
Practice Address - Street 1:2151 HARVEY MITCHELL PKWY S
Practice Address - Street 2:SUITE 112
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5281
Practice Address - Country:US
Practice Address - Phone:979-764-3100
Practice Address - Fax:979-764-3144
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8365Medicare PIN