=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255543385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KREUSCH CHIROPRACTIC CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 ONE HALF NORTH MAIN STREET
-----------------------------------------------------
City | ARCANUM
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45304-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-692-8570
-----------------------------------------------------
Fax | 937-692-8570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 ONE HALF NORTH MAIN STREET
-----------------------------------------------------
City | ARCANUM
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45304-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-692-8570
-----------------------------------------------------
Fax | 937-692-8570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DANIEL R. KREUSCH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 937-692-8570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1951
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------