Provider Demographics
NPI:1497086953
Name:DEJTIRANUKUL, TONY (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:DEJTIRANUKUL
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 1:990 BELVEDERE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1193
Mailing Address - Country:US
Mailing Address - Phone:513-836-8844
Mailing Address - Fax:513-836-8845
Practice Address - Street 1:990 BELVEDERE DR STE B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1193
Practice Address - Country:US
Practice Address - Phone:513-836-8844
Practice Address - Fax:513-836-8845
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor