Provider Demographics
NPI:1609210723
Name:EATON, EMILY ANN (DC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:EATON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3563
Mailing Address - Country:US
Mailing Address - Phone:715-892-1876
Mailing Address - Fax:
Practice Address - Street 1:828 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2536
Practice Address - Country:US
Practice Address - Phone:208-642-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ID2228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program