Provider Demographics
NPI:1326585670
Name:EBAUGH, KIRSTIN MINDY (DC)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:MINDY
Last Name:EBAUGH
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 1:1907 GARDEN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1962
Mailing Address - Country:US
Mailing Address - Phone:541-321-5700
Mailing Address - Fax:541-687-4253
Practice Address - Street 1:1907 GARDEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1962
Practice Address - Country:US
Practice Address - Phone:541-321-5700
Practice Address - Fax:541-687-4253
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5787111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition