Provider Demographics
NPI:1831565084
Name:MITEIKO, BETHANY (PA-C, DC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MITEIKO
Suffix:
Gender:F
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 H ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5350
Mailing Address - Country:US
Mailing Address - Phone:470-384-9444
Mailing Address - Fax:
Practice Address - Street 1:2460 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3207
Practice Address - Country:US
Practice Address - Phone:707-445-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33701111N00000X
CAPA64813363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No111N00000XChiropractic ProvidersChiropractor