Provider Demographics
NPI:1629171905
Name:SHANE D. BASHLINE, INC.
Entity Type:Organization
Organization Name:SHANE D. BASHLINE, INC.
Other - Org Name:BASHLINE CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:BASHLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-968-3610
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
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0378176Medicaid
OH0378176Medicaid