Provider Demographics
NPI:1073695169
Name:BETZ, ERIC A (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:BETZ
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:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-0047
Mailing Address - Country:US
Mailing Address - Phone:207-236-6272
Mailing Address - Fax:207-236-6252
Practice Address - Street 1:2195 ATLANTIC HWY.
Practice Address - Street 2:
Practice Address - City:LINCOLNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04849
Practice Address - Country:US
Practice Address - Phone:207-236-6272
Practice Address - Fax:207-236-6252
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU90582Medicare UPIN
MEMM9432Medicare ID - Type UnspecifiedPROVIDER NUMBER