Provider Demographics
NPI:1912900770
Name:ETTLINGER, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:ETTLINGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7920 MCDONOGH ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5249
Mailing Address - Country:US
Mailing Address - Phone:410-356-9939
Mailing Address - Fax:410-356-9987
Practice Address - Street 1:7920 MCDONOGH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5249
Practice Address - Country:US
Practice Address - Phone:410-356-9939
Practice Address - Fax:410-356-9987
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01788111N00000X
MDS01788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216603800Medicaid
MD216603800Medicaid
245N270GMedicare PIN