Provider Demographics
NPI:1629076344
Name:BASHLINE, SHANE DWIGHT (DC)
Entity Type:Individual
Prefix:
First Name:SHANE
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 EAST HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977-0445
Mailing Address - Country:US
Mailing Address - Phone:740-968-3610
Mailing Address - Fax:740-968-3502
Practice Address - Street 1:432 EAST HIGH STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977
Practice Address - Country:US
Practice Address - Phone:740-968-3610
Practice Address - Fax:740-968-3502
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262924Medicaid
OH000000547449OtherBLUE CROSS
OH0805111OtherUMWA FUNDS MEDICARE
OH350037819OtherRAILROAD MEDICARE
OH4015634Medicare PIN
OH0805111OtherUMWA FUNDS MEDICARE
OH0262924Medicaid