Provider Demographics
NPI:1811982341
Name:KISER, BETH A (DC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:KISER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1875 N RIDGE RD E
Mailing Address - Street 2:STE. A
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3371
Mailing Address - Country:US
Mailing Address - Phone:440-277-9355
Mailing Address - Fax:440-277-9393
Practice Address - Street 1:1875 N RIDGE RD E
Practice Address - Street 2:STE. A
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3371
Practice Address - Country:US
Practice Address - Phone:440-277-9355
Practice Address - Fax:440-277-9393
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC 2958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000332145OtherANTHEM BLUE CROSS
OH2255956Medicaid
U66822Medicare UPIN
OH4064213Medicare PIN