Provider Demographics
NPI:1821054784
Name:ESCH, CLYDE W (DC, FACO, DABFP)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:W
Last Name:ESCH
Suffix:
Gender:M
Credentials:DC, FACO, DABFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2760
Mailing Address - Country:US
Mailing Address - Phone:937-477-0305
Mailing Address - Fax:
Practice Address - Street 1:7021 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2760
Practice Address - Country:US
Practice Address - Phone:937-477-0305
Practice Address - Fax:937-477-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH731111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH433892Medicaid
OHT47043Medicare UPIN
OH4032291Medicare UPIN
OHES4032291Medicare ID - Type UnspecifiedMEDICARE