Provider Demographics
NPI:1801851944
Name:ZEITER, EDMUND JOSEPH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:ZEITER
Suffix:JR
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 1:1212 WEST ROBINHOOD DRIVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-474-8215
Mailing Address - Fax:209-474-8953
Practice Address - Street 1:1212 WEST ROBINHOOD DRIVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-474-8215
Practice Address - Fax:209-474-8953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5749OtherUPIN
WA5749OtherUPIN
V02767Medicare UPIN