Provider Demographics
NPI:1700090263
Name:THOMAS J. KREUSCH, JR. D.C. INC.
Entity Type:Organization
Organization Name:THOMAS J. KREUSCH, JR. D.C. INC.
Other - Org Name:KREUSCH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KREUSCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:937-382-1095
Mailing Address - Street 1:24 RANDOLPH ST STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2786
Mailing Address - Country:US
Mailing Address - Phone:937-382-1095
Mailing Address - Fax:937-382-3739
Practice Address - Street 1:24 RANDOLPH ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2786
Practice Address - Country:US
Practice Address - Phone:937-382-1095
Practice Address - Fax:937-382-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0610717Medicaid
OH0610717Medicaid
OHT48329Medicare UPIN