Provider Demographics
NPI:1447250956
Name:BETHEL, CLIFTON DAVID (DC, MS)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:DAVID
Last Name:BETHEL
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 E 53RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2701
Mailing Address - Country:US
Mailing Address - Phone:563-344-0707
Mailing Address - Fax:563-344-6769
Practice Address - Street 1:2303 E 53RD ST STE 3
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2701
Practice Address - Country:US
Practice Address - Phone:563-344-0707
Practice Address - Fax:563-344-6769
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2019-03-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-07-31
Provider Licenses
StateLicense IDTaxonomies
IL038008347111N00000X
FLCH10008111N00000X
IA007048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08122452OtherBLUE CROSS/BLUE SHIELD
IL08122452OtherBLUE CROSS/BLUE SHIELD
IL08122452OtherBLUE CROSS/BLUE SHIELD