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General NPI Number Information
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NPI Number | 1205963501
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Entity Type | Organization
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Legal Business Name | EAST SIDE CHIROPRACTIC INJURY TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4325 AIRWAY RD
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City | DAYTON
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State | OH
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Zip | 45431-1327
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Country | US
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Telephone | 937-256-4951
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Fax | 937-256-5268
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Provider Business Mailing Address
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Address Line | 4325 AIRWAY RD
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City | DAYTON
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State | OH
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Zip | 45431-1327
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Country | US
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Telephone | 937-256-4951
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Fax | 937-256-5268
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN D LEHANE
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Credential | DC
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Telephone | 937-256-4951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2923
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License Number State | OH
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