Provider Demographics
NPI:1215776026
Name:GEORGE ETZL
Entity type:Organization
Organization Name:GEORGE ETZL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ETZL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-431-9191
Mailing Address - Street 1:41-45 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1966
Mailing Address - Country:US
Mailing Address - Phone:607-431-9191
Mailing Address - Fax:607-441-5051
Practice Address - Street 1:41-45 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1966
Practice Address - Country:US
Practice Address - Phone:607-431-9191
Practice Address - Fax:607-441-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty