Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X010988 | NY |
N | 111NI0013X | Independent Medical Examiner | X010988 | NY |
NPI | 1447464987 |
---|---|
Provider Name | Dr. George J Etzl |
First Address | Oneonta, NY 13820-1855 |
Second Address | Oneonta, NY 13820-1855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 27/06/2013 |