Provider Demographics
NPI:1932490364
Name:OGI, THOMAS NATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NATHAN
Last Name:OGI
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 1:1040 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9590
Mailing Address - Country:US
Mailing Address - Phone:262-477-1040
Mailing Address - Fax:262-247-0645
Practice Address - Street 1:1040 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-9590
Practice Address - Country:US
Practice Address - Phone:262-477-1040
Practice Address - Fax:262-247-0645
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4743-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100020814Medicaid