Healthcare Provider Details

I. General information

NPI: 1386642809
Provider Name (Legal Business Name): JOHN DWIGHT BASHLINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 HIGH ST BOX 445
FLUSHING OH
43977-9733
US

IV. Provider business mailing address

432 HIGH ST P.O. BOX 445
FLUSHING OH
43977-9733
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-3610
  • Fax: 740-968-3502
Mailing address:
  • Phone: 740-968-3610
  • Fax: 740-968-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: