Provider Demographics
NPI:1457591349
Name:MIDDLETOWN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:MIDDLETOWN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-727-9199
Mailing Address - Street 1:23998 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-9653
Mailing Address - Country:US
Mailing Address - Phone:812-656-8300
Mailing Address - Fax:
Practice Address - Street 1:23998 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-9653
Practice Address - Country:US
Practice Address - Phone:812-656-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2072261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962230Medicaid
OH0962230Medicaid
OHTHO755981Medicare PIN