Provider Demographics
NPI:1619001971
Name:TOM MENENDEZ ENTERPRISES, INC.
Entity Type:Organization
Organization Name:TOM MENENDEZ ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-246-2225
Mailing Address - Street 1:101 HERITAGE SQ
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1863
Mailing Address - Country:US
Mailing Address - Phone:812-246-2225
Mailing Address - Fax:812-243-0943
Practice Address - Street 1:101 HERITAGE SQ
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1863
Practice Address - Country:US
Practice Address - Phone:812-246-2225
Practice Address - Fax:812-243-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000075222OtherANTHEM
IN100384510BMedicaid
IN200414900AMedicaid
IN350050942Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN200414900AMedicaid
232680Medicare PIN