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General NPI Number Information
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NPI Number | 1700090263
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Entity Type | Organization
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Legal Business Name | THOMAS J. KREUSCH, JR. D.C. INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 24 RANDOLPH ST STE B
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City | WILMINGTON
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State | OH
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Zip | 45177-2786
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Country | US
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Telephone | 937-382-1095
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Fax | 937-382-3739
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Provider Business Mailing Address
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Address Line | 24 RANDOLPH ST STE B
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City | WILMINGTON
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State | OH
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Zip | 45177-2786
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Country | US
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Telephone | 937-382-1095
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Fax | 937-382-3739
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS JOHN KREUSCH JR.
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Credential | D.C.
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Telephone | 937-382-1095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1057
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License Number State | OH
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