Provider Demographics
NPI:1093734634
Name:POITINGER, DAVID (CCSP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:POITINGER
Suffix:
Gender:M
Credentials:CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-0341
Mailing Address - Country:US
Mailing Address - Phone:937-592-9545
Mailing Address - Fax:937-592-9790
Practice Address - Street 1:4859 W SYLVANIA AVE
Practice Address - Street 2:STE B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3371
Practice Address - Country:US
Practice Address - Phone:937-592-9545
Practice Address - Fax:937-592-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000142991OtherANTHEM
OH0197602Medicaid
OHPO0384824Medicare ID - Type UnspecifiedMEDICARE
OH0197602Medicaid