Healthcare Provider Details

I. General information

NPI: 1205160546
Provider Name (Legal Business Name): ESLY S CALDWELL III LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 PFEIFFER RD
CINCINNATI OH
45242-5862
US

IV. Provider business mailing address

2215 UPLAND PL
CINCINNATI OH
45206-2212
US

V. Phone/Fax

Practice location:
  • Phone: 513-985-6772
  • Fax:
Mailing address:
  • Phone: 513-254-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC048
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: