Provider Demographics
NPI:1447266630
Name:ETKA, ERIC C (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:ETKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1632
Mailing Address - Country:US
Mailing Address - Phone:570-882-8081
Mailing Address - Fax:570-888-4998
Practice Address - Street 1:224 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1632
Practice Address - Country:US
Practice Address - Phone:570-882-8081
Practice Address - Fax:570-888-4998
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-07917-L111N00000X
NYX009931-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAET-605975OtherBC/BS NUMBER
PAET-047484Medicare ID - Type UnspecifiedMEDICARE NUMBER