Healthcare Provider Details

I. General information

NPI: 1326585670
Provider Name (Legal Business Name): KIRSTIN MINDY EBAUGH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTIN MINDY RIUTTA DC

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 RIVER RD
EUGENE OR
97404-2653
US

IV. Provider business mailing address

1660 RIVER RD
EUGENE OR
97404-2653
US

V. Phone/Fax

Practice location:
  • Phone: 541-525-0095
  • Fax: 541-284-2099
Mailing address:
  • Phone: 541-525-0095
  • Fax: 541-284-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5787
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5787
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number5787
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number5787
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: