Provider Demographics
NPI:1013157684
Name:JTDC, INC
Entity type:Organization
Organization Name:JTDC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:KIPP
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-967-2225
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-0343
Mailing Address - Country:US
Mailing Address - Phone:740-967-2225
Mailing Address - Fax:740-967-8907
Practice Address - Street 1:620 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9580
Practice Address - Country:US
Practice Address - Phone:740-967-2225
Practice Address - Fax:740-967-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0142965Medicaid
U40845Medicare UPIN