Healthcare Provider Details

I. General information

NPI: 1013903186
Provider Name (Legal Business Name): THOMAS J NEWBAUER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N WOLFENBERGER ST
SULLIVAN IN
47882-7242
US

IV. Provider business mailing address

777 N WOLFENBERGER ST
SULLIVAN IN
47882-7242
US

V. Phone/Fax

Practice location:
  • Phone: 812-230-9055
  • Fax:
Mailing address:
  • Phone: 812-230-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001643A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001634A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: