Provider Demographics
NPI:1407060148
Name:MATTHEW ASHKETTLE, D.C.,LLC
Entity Type:Organization
Organization Name:MATTHEW ASHKETTLE, D.C.,LLC
Other - Org Name:EAST SIDE CHIROPRACTIC INJURY AND TREAMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:ASHKETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-901-9695
Mailing Address - Street 1:4325 AIR WAY RD.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:614-901-9695
Mailing Address - Fax:614-901-9720
Practice Address - Street 1:4325 AIR WAY RD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:614-901-9695
Practice Address - Fax:614-901-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365784Medicaid
OH4095951Medicare ID - Type Unspecified