Provider Demographics
NPI:1578787099
Name:KRUEGER, THOMAS GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERALD
Last Name:KRUEGER
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 1:726 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1900
Mailing Address - Country:US
Mailing Address - Phone:513-933-9799
Mailing Address - Fax:513-933-0866
Practice Address - Street 1:726 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1900
Practice Address - Country:US
Practice Address - Phone:513-933-9799
Practice Address - Fax:513-933-0866
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1885111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964587Medicaid
OH0964587Medicaid
OHU35416Medicare UPIN