Provider Demographics
NPI:1659430635
Name:BEISTLINE, ERIC THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:THOMAS
Last Name:BEISTLINE
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-0026
Mailing Address - Country:US
Mailing Address - Phone:937-864-1404
Mailing Address - Fax:937-864-2366
Practice Address - Street 1:340 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1058
Practice Address - Country:US
Practice Address - Phone:937-864-1404
Practice Address - Fax:937-864-2366
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1066659OtherAMERICAN SPECIALTY HEALTH
OH7565561OtherAETNA INDIVIDUAL NUMBER
OH20060717473204033OtherAMERICAN WHOLE HEALTH
OH000000384971OtherANTHEM BC BS
OH2472060Medicaid
OH666124OtherACN GROUP
OH861145389OtherHEALTHSPAN
OH7565561OtherAETNA INDIVIDUAL NUMBER