Provider Demographics
NPI:1427080761
Name:ETERIAN, LILLIAN E (DC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:E
Last Name:ETERIAN
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 1:16 MANNING ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038
Mailing Address - Country:US
Mailing Address - Phone:603-434-1177
Mailing Address - Fax:603-434-9992
Practice Address - Street 1:16 MANNING ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-434-1177
Practice Address - Fax:603-434-9992
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5521298111N00000X
MACH1306111N00000X
RIDC00272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1725085OtherCIGNA
NH2516824OtherAETNA
T53559OtherHARVARD PILGRIM HLTHCARE
NH30252493Medicaid
338764OtherPHCS
05Y003758NH03OtherANTHEM
NH30252493Medicaid