=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598944282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN HILLS CHIROPRACTIC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 06/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 684 OLD STATE ROUTE 74
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45245-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-528-2200
-----------------------------------------------------
Fax | 513-528-7991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 684 OLD STATE ROUTE 74
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45245-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-528-2200
-----------------------------------------------------
Fax | 513-528-7991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. JOSEPH LYNN EVERHART
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 513-528-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1224
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------