Provider Demographics
NPI:1700940376
Name:JICHA, THOMAS G (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:JICHA
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 1:1233 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2728
Mailing Address - Country:US
Mailing Address - Phone:419-227-8435
Mailing Address - Fax:419-227-1772
Practice Address - Street 1:1233 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2728
Practice Address - Country:US
Practice Address - Phone:419-227-8435
Practice Address - Fax:419-227-1772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0619754Medicaid
OH0619754Medicaid
OH0604001Medicare PIN