Provider Demographics
NPI:1619007713
Name:FIRESTINE, KEVIN LANE (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LANE
Last Name:FIRESTINE
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 1:3700 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-801-1307
Mailing Address - Fax:206-338-5544
Practice Address - Street 1:844 S 30TH ST
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1254
Practice Address - Country:US
Practice Address - Phone:614-801-9081
Practice Address - Fax:614-801-9095
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor