Provider Demographics
NPI:1851326334
Name:PIETRYLKA, ERIC J (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:PIETRYLKA
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 1:9927 E BELL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2411
Mailing Address - Country:US
Mailing Address - Phone:480-505-9681
Mailing Address - Fax:480-505-9685
Practice Address - Street 1:9927 E BELL RD STE 140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2411
Practice Address - Country:US
Practice Address - Phone:480-505-9681
Practice Address - Fax:480-505-9685
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79211Medicare ID - Type Unspecified
AZU99213Medicare UPIN