Provider Demographics
NPI:1083150478
Name:HOMAN, JOHN CLETUS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLETUS
Last Name:HOMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2000
Mailing Address - Country:US
Mailing Address - Phone:419-586-8600
Mailing Address - Fax:
Practice Address - Street 1:913 W LOGAN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2000
Practice Address - Country:US
Practice Address - Phone:419-586-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor