Healthcare Provider Details

I. General information

NPI: 1831565084
Provider Name (Legal Business Name): BETHANY MITEIKO PA-C, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 BUHNE ST
EUREKA CA
95501-3207
US

IV. Provider business mailing address

3134 H ST
EUREKA CA
95503-5350
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-3075
  • Fax:
Mailing address:
  • Phone: 470-384-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC33701
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA64813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: