Provider Demographics
NPI:1407902273
Name:KLUG, JOHN F (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:KLUG
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 1:410 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1341
Mailing Address - Country:US
Mailing Address - Phone:978-458-6620
Mailing Address - Fax:978-458-6671
Practice Address - Street 1:410 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1341
Practice Address - Country:US
Practice Address - Phone:978-458-6620
Practice Address - Fax:978-458-6671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA48277OtherHARVARD PILGRIM HEALTH CA
MAY36962OtherBCBS OF MASSECHUSETTS