Healthcare Provider Details

I. General information

NPI: 1457474694
Provider Name (Legal Business Name): EASTLAND CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4261 KIMBERLY PKWY
COLUMBUS OH
43232-7226
US

IV. Provider business mailing address

3696 GARDEN CT
GROVE CITY OH
43123-2906
US

V. Phone/Fax

Practice location:
  • Phone: 614-755-7700
  • Fax: 614-755-9634
Mailing address:
  • Phone: 614-801-1307
  • Fax: 614-277-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3510
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010968
License Number StateOH

VIII. Authorized Official

Name: MRS. SARAH ROTHGEB
Title or Position: BILLING SPECIALIST
Credential:
Phone: 614-801-1307