Provider Demographics
NPI:1255543385
Name:KREUSCH CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:KREUSCH CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KREUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-692-8570
Mailing Address - Street 1:601 ONE HALF NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-1401
Mailing Address - Country:US
Mailing Address - Phone:937-692-8570
Mailing Address - Fax:937-692-8570
Practice Address - Street 1:601 ONE HALF NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-1401
Practice Address - Country:US
Practice Address - Phone:937-692-8570
Practice Address - Fax:937-692-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000006283161OtherANTHEM
OH1295874162OtherNPI
OHKR0735012Medicare ID - Type Unspecified