1386642809 NPI number — JOHN DWIGHT BASHLINE D.C.

Table of content: JOHN DWIGHT BASHLINE D.C. (NPI 1386642809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386642809 NPI number — JOHN DWIGHT BASHLINE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASHLINE
Provider First Name:
JOHN
Provider Middle Name:
DWIGHT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386642809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
432 HIGH ST
Provider Second Line Business Mailing Address:
P.O. BOX 445
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43977-9733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-968-3610
Provider Business Mailing Address Fax Number:
740-968-3502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
432 HIGH ST
Provider Second Line Business Practice Location Address:
BOX 445
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43977-9733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-968-3610
Provider Business Practice Location Address Fax Number:
740-968-3502
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  254 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0432633 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0984019 . This is a "UMWA MEDICARE FUNDS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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