Provider Demographics
NPI:1447464987
Name:ETZL, GEORGE J (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:ETZL
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 1:41-45 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41-45 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1855
Practice Address - Country:US
Practice Address - Phone:607-431-9191
Practice Address - Fax:607-431-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010988111NI0013X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0439Medicare ID - Type UnspecifiedPROVIDER NUMBER