Provider Demographics
NPI:1053484543
Name:EASH, KRISTEN DIANE (DC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DIANE
Last Name:EASH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1438
Mailing Address - Country:US
Mailing Address - Phone:330-939-3191
Mailing Address - Fax:330-939-1101
Practice Address - Street 1:14 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1438
Practice Address - Country:US
Practice Address - Phone:330-939-3191
Practice Address - Fax:330-485-4530
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2596089Medicaid
OH2596089Medicaid
V06216Medicare UPIN