Provider Demographics
NPI:1861253882
Name:HATULAN, BETHANY (DC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:HATULAN
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 1:1657 PHAM DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7404
Mailing Address - Country:US
Mailing Address - Phone:540-903-7043
Mailing Address - Fax:
Practice Address - Street 1:1657 PHAM DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7404
Practice Address - Country:US
Practice Address - Phone:540-903-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor