Provider Demographics
NPI:1386642809
Name:BASHLINE, JOHN DWIGHT (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DWIGHT
Last Name:BASHLINE
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 1:432 HIGH ST
Mailing Address - Street 2:P.O. BOX 445
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977-9733
Mailing Address - Country:US
Mailing Address - Phone:740-968-3610
Mailing Address - Fax:740-968-3502
Practice Address - Street 1:432 HIGH ST
Practice Address - Street 2:BOX 445
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977-9733
Practice Address - Country:US
Practice Address - Phone:740-968-3610
Practice Address - Fax:740-968-3502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH254111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432633Medicaid
OH0984019OtherUMWA MEDICARE FUNDS
OHT46345Medicare UPIN
OH0432633Medicaid
OH4015371Medicare ID - Type UnspecifiedFLUSHING OFFICE