Provider Demographics
NPI:1326098369
Name:REDFIELD, THOMAS CULVER JR (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CULVER
Last Name:REDFIELD
Suffix:JR
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 1:7822 E. 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342
Mailing Address - Country:US
Mailing Address - Phone:219-962-8128
Mailing Address - Fax:219-962-1764
Practice Address - Street 1:7822 E. 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342
Practice Address - Country:US
Practice Address - Phone:219-962-8128
Practice Address - Fax:219-962-1764
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001300A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100202370AMedicaid
IN96565OtherBC/BS PIN NUMBER
IN256306OtherANTHEM PIN NUMBER
IN84-0965279OtherPROVIDER TAX ID
INU03263Medicare UPIN
IN256306OtherANTHEM PIN NUMBER