Provider Demographics
NPI:1215358726
Name:ETEMADI, DUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:ETEMADI
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 1:4810 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-5008
Mailing Address - Country:US
Mailing Address - Phone:281-292-7525
Mailing Address - Fax:281-292-6119
Practice Address - Street 1:4810 W. PANTHER CREEK DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381
Practice Address - Country:US
Practice Address - Phone:281-292-7525
Practice Address - Fax:281-292-6119
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor