Provider Demographics
NPI:1750343349
Name:EASTMAN, AMY LOU (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOU
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOU
Other - Last Name:MORVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:234 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820
Mailing Address - Country:US
Mailing Address - Phone:419-562-4242
Mailing Address - Fax:419-562-4979
Practice Address - Street 1:234 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820
Practice Address - Country:US
Practice Address - Phone:419-562-4242
Practice Address - Fax:419-562-4979
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0129604Medicaid
OH0129604Medicaid
OHEA0780423Medicare ID - Type Unspecified
U56061Medicare UPIN
OHEA0780424Medicare ID - Type Unspecified