Provider Demographics
NPI:1013903186
Name:NEWBAUER, THOMAS J (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NEWBAUER
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 1:777 N WOLFENBERGER ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7242
Mailing Address - Country:US
Mailing Address - Phone:812-230-9055
Mailing Address - Fax:
Practice Address - Street 1:777 N WOLFENBERGER ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7242
Practice Address - Country:US
Practice Address - Phone:812-230-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001643A111N00000X
IN08001634A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000340406OtherANTHEM
INU58436Medicare UPIN
IN000000340406OtherANTHEM