Provider Demographics
NPI:1730295718
Name:KLOIBER, THOMAS CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CARL
Last Name:KLOIBER
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 1:1942 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2724
Mailing Address - Country:US
Mailing Address - Phone:920-458-1942
Mailing Address - Fax:
Practice Address - Street 1:1510 S 12TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5244
Practice Address - Country:US
Practice Address - Phone:920-457-1510
Practice Address - Fax:920-457-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38781300Medicaid
WI38781300Medicaid