MEDICARE: BETH A KISER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC 2958	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000332145	OTHER	OH	ANTHEM BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811982341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A KISER DC

Provider Business Mailing Address
First Line	:	1875 N RIDGE RD E
Second Line	:	STE. A
City	:	LORAIN
State	:	OH
Zip	:	44055-3371
Country	:	US
Telephone Number	:	440-277-9355
Fax Number	:	440-277-9393

Provider Business Practice Location Address
First Line	:	1875 N RIDGE RD E
Second Line	:	STE. A
City	:	LORAIN
State	:	OH
Zip	:	44055-3371
Country	:	US
Telephone Number	:	440-277-9355
Fax Number	:	440-277-9393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/15/2016

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Directions to “ BETH A KISER DC” Practice Location

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