Provider Demographics
NPI:1710059191
Name:LONERGAN, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:LONERGAN
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 1:956 OLD STATE ROUTE 74
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2360
Mailing Address - Country:US
Mailing Address - Phone:513-943-1139
Mailing Address - Fax:513-943-9131
Practice Address - Street 1:956 OLD STATE ROUTE 74
Practice Address - Street 2:SUITE 3
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2360
Practice Address - Country:US
Practice Address - Phone:513-943-1139
Practice Address - Fax:513-943-9131
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLO4099821Medicare ID - Type UnspecifiedPROVIDER NUMBER