Provider Demographics
NPI:1356381099
Name:EISELT, THOMAS E (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:EISELT
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 1:45 E SIDE SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2671
Mailing Address - Country:US
Mailing Address - Phone:309-647-3502
Mailing Address - Fax:
Practice Address - Street 1:45 E SIDE SQ STE 101
Practice Address - Street 2:STE 101
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2671
Practice Address - Country:US
Practice Address - Phone:309-647-3502
Practice Address - Fax:309-647-3698
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3683111N00000X
IL038011266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300P9HEOtherBCBS OF MN GROUP#
MN892727800Medicaid
MN350003108Medicare ID - Type UnspecifiedMEDICARE IND #
MNT65481Medicare UPIN