Healthcare Provider Details

I. General information

NPI: 1003093220
Provider Name (Legal Business Name): JON ANTHONY KREMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 S PEARL ST
VERSAILLES OH
45380-1111
US

IV. Provider business mailing address

567 S PEARL ST
VERSAILLES OH
45380-1111
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-4353
  • Fax: 937-526-4360
Mailing address:
  • Phone: 937-526-4353
  • Fax: 937-526-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: