Healthcare Provider Details

I. General information

NPI: 1659430635
Provider Name (Legal Business Name): ERIC THOMAS BEISTLINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 DAYTON SPRINGFIELD RD
SPRINGFIELD OH
45506-1758
US

IV. Provider business mailing address

PO BOX 26
ENON OH
45323-0026
US

V. Phone/Fax

Practice location:
  • Phone: 937-864-1404
  • Fax: 937-717-0207
Mailing address:
  • Phone: 937-864-1404
  • Fax: 937-864-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: