Provider Demographics
NPI:1447830880
Name:ESHMAN CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:ESHMAN CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:ESHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-779-0773
Mailing Address - Street 1:511 SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9204
Mailing Address - Country:US
Mailing Address - Phone:412-779-0773
Mailing Address - Fax:
Practice Address - Street 1:11599 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2061
Practice Address - Country:US
Practice Address - Phone:412-779-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031153000002Medicaid