Provider Demographics
NPI:1780798983
Name:EBERLINE, PAUL DOUGLAS (DC,DACBN)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:EBERLINE
Suffix:
Gender:M
Credentials:DC,DACBN
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 52
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-0052
Mailing Address - Country:US
Mailing Address - Phone:319-824-3650
Mailing Address - Fax:319-824-6780
Practice Address - Street 1:412 G AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1747
Practice Address - Country:US
Practice Address - Phone:319-824-3650
Practice Address - Fax:319-824-6780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04688111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166553Medicaid
IAT00981Medicare UPIN
IA0166553Medicaid