Provider Demographics
NPI:1417020447
Name:KLEPTACH, JOHN S (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:KLEPTACH
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 1:1170 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4272
Mailing Address - Country:US
Mailing Address - Phone:330-494-7158
Mailing Address - Fax:330-494-7184
Practice Address - Street 1:1170 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4272
Practice Address - Country:US
Practice Address - Phone:330-494-7158
Practice Address - Fax:330-494-7184
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000140409OtherBLUE CROSS BLUE SHIELD
OH0239423Medicaid
OH000000140409OtherBLUE CROSS BLUE SHIELD
OH0239423Medicaid