Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1287 | ID |
N | 111N00000X | Chiropractor | 4022 | OR |
NPI | 1003092248 |
---|---|
Provider Name | Dr. Mark Anthony Betsill |
First Address | Gresham, OR 97030-8553 |
Second Address | Gresham, OR 97030-8553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 08/12/2020 |