Provider Demographics
NPI:1770663528
Name:KREUSCH, MARK JEROME (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEROME
Last Name:KREUSCH
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 1:3225 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9319
Mailing Address - Country:US
Mailing Address - Phone:937-524-2437
Mailing Address - Fax:
Practice Address - Street 1:5 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1264
Practice Address - Country:US
Practice Address - Phone:937-836-3313
Practice Address - Fax:937-836-9693
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU60364Medicare UPIN