Provider Demographics
NPI:1982894655
Name:ERIC T. BEISTLINE, D.C., LTD
Entity Type:Organization
Organization Name:ERIC T. BEISTLINE, D.C., LTD
Other - Org Name:BEISTLINE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BEISTLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-864-1404
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7931744OtherAETNA GROUP ID
OHER9357701Medicare PIN
OH7931744OtherAETNA GROUP ID