Provider Demographics
NPI:1730167412
Name:BADSTIBNER, ERIC K (DC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:K
Last Name:BADSTIBNER
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 1:3045 JACKS RUN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2523
Mailing Address - Country:US
Mailing Address - Phone:412-678-9123
Mailing Address - Fax:412-678-9127
Practice Address - Street 1:3045 JACKS RUN RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2523
Practice Address - Country:US
Practice Address - Phone:412-678-9123
Practice Address - Fax:412-678-9127
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101125290001Medicaid
PA410512OtherUPMC PROVIDER
PA410512OtherUPMC PROVIDER
PA0892463KSPMedicare ID - Type Unspecified